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09-05-2012 | Physical rehabilitation | Article

Improving communication for ventilator-dependent patients

Abstract

Free abstract

MedWire News: The Blom tracheotomy tube with inner speech cannula may help patients requiring tracheotomy and mechanical ventilation to communicate more easily, suggest researchers.

Cuffed speaking tracheotomy tubes exist that allow ventilator-dependent patients to communicate verbally.

"However, voice and speech production are precluded in patients who require mechanical ventilation with an inflated tracheotomy tube cuff because pulmonary air cannot enter the larynx," explain Steven Leder (Yale University School of Medicine, New Haven, Connecticut, USA) and colleagues in Head and Neck.

Two options currently exist for these patients to enable speech. The first involves using an independent gas source that allows the tracheotomy tube cuff to stay inflated while the respiratory circuit stays closed. But this option has been known to cause problems and has variable efficacy due to air-line connection difficulties and variable air flow rates.

The second, the Blom tracheotomy tube, uses a novel speech inner cannula with a valve system that directs all inspired air from the ventilator in to the lungs without interfering with the larynx.

In the current study, Leder and team tested the efficacy of the Blom tracheotomy tube system for enabling understandable speech.

In total, 23 adult inpatients tested the system, all of whom achieved audible voicing.

The voice intensity achieved by the participants was more than 10 dB SPL greater than ambient room noise. Speech intelligibility also improved significantly from 80% prior to Blom tracheotomy tube insertion to 85% after insertion. Phonation duration ranged from 3.30 to 3.45 seconds.

Notably, there were no significant changes in oxygen saturation with the new device and no significant complications were observed.

"The Blom tracheotomy tube with speech inner cannula is the only device available that directs the entire exhaled volume of air into the upper airway while simultaneously permitting full cuff inflation during mechanical ventilation," say the authors.

They conclude: "Use of this device allowed for successful voice and speech production that were significantly louder than ambient room noise, thereby permitting renewed ability for successful, proficient, and intelligible verbal communication for both acute care and rehabilitation patients."

By Helen Albert

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