Voice‐Related Quality of Life Increases With a Talking Tracheostomy Tube: A Randomized Controlled Trial

Pandian, Vinciya; Cole, Therese; Kilonsky, Dana; Holden, Kate; Feller‐Kopman, David; Brower, Roy G.; Mirski, Marek A.

doi:10.1002/lary.28211

Cited by 24 publications

(36 citation statements)

References 17 publications

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“… 59 One randomised controlled trial used talk tubes and found significant improvements in voice-related quality of life. 53 Another used in-line speaking valves and favoured the use of in-line valves over one-way speaking valve but found that the improvement in quality of life was not statistically significant. 44 …”

Section: Resultsmentioning

confidence: 99%

Management of tracheostomies in the intensive care unit: a scoping review

2020

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ObjectivesWhile there is an extensive body of literature surrounding the decision to insert, and methods for inserting, a tracheostomy, the optimal management of tracheostomies within the intensive care unit (ICU) from after insertion until ICU discharge is not well understood. The objective was to identify and map the key concepts relating to, and identify research priorities for, postinsertion management of adult patients with tracheostomies in the ICU.DesignScoping review of the literature.Data sourcesPubMed, Embase and Cumulative Index to Nursing and Allied Health Literature were searched from inception to 3 October 2019. Additional sources were searched for published and unpublished literature.Eligibility criteriaWe included studies of any methodology that addressed the a priori key questions relating to tracheostomy management in the ICU. No restrictions were placed on language or year of publication.Data extraction and synthesisTitles and abstracts were screened by two reviewers. Studies that met inclusion criteria were reviewed in full by two reviewers, with discrepancies resolved by a third. Data were extracted for included studies, and results mapped along the prespecified research questions.Results6132 articles were screened, and 102 articles were included for detailed analysis. Protocolised weaning was found to be successful in liberating patients from the ventilator in several cohort studies. Observational studies showed that strategies that use T-pieces and high-flow oxygen delivery improve weaning success. Several lines of evidence, including one clinical trial, support early cuff deflation as a safe and effective strategy as it results in a reduced time to wean, shorter ICU stays and fewer complications. Early tracheostomy downsizing and/or switching to cuffless tubes was found to be of benefit in one study. A substantial body of evidence supports the use of speaking valves to facilitate communication. While this does not influence time to wean or incidence of complications, it is associated with a major benefit in patient satisfaction and experience. Use of care bundles and multidisciplinary team approaches have been associated with reduced complications and improved outcomes in several observational studies.ConclusionsThe limited body of evidence supports use of weaning protocols, early cuff deflation, use of speaking valves and multidisciplinary approaches. Clinical trials examining post-tracheostomy management strategies in ICUs are a priority.

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Section: Resultsmentioning

confidence: 99%

Management of tracheostomies in the intensive care unit: a scoping review

2020

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“…[6][7][8][12][13][14][15][16][17][18][19]21,22,24 Furthermore, ACV could improve V-RQOL and QOL-MV. 23 Several minor complications (eg, discomfort, excessive secretion, cuff breakage) were described. 7,8,[14][15][16][17]19,24 Moreover, two serious adverse events (ie, tracheal distention and subcutaneous emphysema) resulted from the incorrect application of the method and incorrectly placed tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

“…Two RCTs including 75 patients reported V-RQOL and QOL-MV. 20,23 In the first pilot RCT there were no significant differences between the intervention (n = 15) and control groups (n = 10). 20 The overall quality of evidence for the effect on QOL according to GRADE was very low (Table 2).…”

Section: Quality Of Lifementioning

confidence: 95%

“…7,[18][19][20][21][22] Two randomised controlled clinical trials (RCT) with 75 patients assessing QOL related to the effect of ACV on speech were also included (Table 1). 20,23 Age of patients, when reported, ranged from 14 to 83 years. 6,7,[12][13][14][15][16][17][18][19][21][22][23][24] F I G U R E 2 Flow diagram of the study selection procedure…”

Section: Characteristics Of Sources Of Evidencementioning

confidence: 99%

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Above cuff vocalisation (ACV): A scoping review

Petosic

Viravong

Martin

et al. 2020

Acta Anaesthesiol Scand

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Introduction Patients in intensive care frequently suffer from not being able to communicate verbally. The aim of this scoping review was to study the safety and effectiveness of the above cuff vocalisation (ACV) on speech and quality of life (QOL) in patients dependent on a cuffed tracheostomy. Methods A scoping review was conducted. The databases Ovid Medline, Cochrane Library, and Embase were systematically searched in May 2020. We included clinical studies with patients exposed to ACV where speech, QOL or safety issues were assessed. Results Overall, 17 studies were included, of which 15 were observational and 2 were randomised controlled trials. Totally, 231 patients were included. ACV enabled most of the included patients (115/131; 88%) to speak with an audible voice or whisper (moderate quality of evidence). Voice related QOL (V‐RQOL) and QOL in mechanically ventilated patients (QOL‐MV) improved from pre‐ to post‐ ACV compared to a control group not tolerating a one‐way speaking valve (P = .01 and P = .04, respectively) (very low quality of evidence). Several minor complications or problems were reported in 20/75 (27%) cases in addition to two serious adverse events: subcutaneous emphysema in one patient where the tracheostomy was dislodged and a distended trachea in another due to the misconnection of continuous gas to the cuff (low/ very low quality of evidence). Conclusion ACV facilitated communication in patients dependent on a cuffed tracheostomy and attempting to communicate. Quality of evidence in improved V‐RQOL and QOL‐MV was very low. Several minor complications and two serious adverse events were reported.

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“…127 Patients benefit from reductions in anxiety, shorter times to vocalisation, and earlier oral intake after tracheostomy. 127,149,150 The ability to track these metrics over time and benchmark between sites will add rigor to comparisons as the database expands. The UK Improving Tracheostomy Care project, reported in this issue, details not just the potential quality, safety, and economic impact, but also affords powerful insights into strategies for changes that are likely reproducible in sites around the world.…”

Section: Discussionmentioning

confidence: 99%