Optimizing Communication in Mechanically Ventilated Patients.

NIH Public Access Author Manuscript J Med Speech Lang Pathol. Author manuscript; available in PMC 2014 November 24.

NIH-PA Author Manuscript

Published in final edited form as: J Med Speech Lang Pathol. 2014 ; 21(4): 309–318.

Optimizing Communication in Mechanically Ventilated Patients Vinciya Pandian, Ph.D, RN, ACNP-BC, Percutaneous Tracheostomy Service, The Johns Hopkins Hospital, Baltimore, MD Christine P. Smith, M.S., CCC-SLP, Speech-Language Pathology, The Johns Hopkins Hospital, Baltimore, MD Therese Kling Cole, M.A., CCC-SLP, Speech-Language Pathology, The Johns Hopkins Hospital, Baltimore, MD Nasir I. Bhatti, M.D., M.H.S., Otolaryngology Head-Neck Surgery, The Johns Hopkins Hospital, Baltimore, MD


Marek A. Mirski, M.D., Ph.D., Anesthesia Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD Lonny B. Yarmus, D.O., and Interventional Pulmonary, The Johns Hopkins Hospital, Baltimore, MD David J. Feller-Kopman, M.D. Interventional Pulmonary, The Johns Hopkins Hospital, Baltimore, MD

Abstract Purpose—To describe the types of talking tracheostomy tubes available, present four case studies of critically ill patients who used a specialized tracheostomy tube to improve speech, discuss their advantages and disadvantages, propose patient selection criteria, and provide practical recommendations for medical care providers. Methods—Retrospective chart review of patients who underwent tracheostomy in 2010.


Results—Of the 220 patients who received a tracheostomy in 2010, 164 (74.55%) received a percutaneous tracheostomy and 56 (25.45%) received an open tracheostomy. Among the percutaneous tracheostomy patients, speech-language pathologists were consulted on 113 patients, 74 of whom were on a ventilator. Four of these 74 patients received a talking tracheostomy tube, and all four were able to speak successfully while on the mechanical ventilator even though they were unable to tolerate cuff deflation. Conclusions—Talking tracheostomy tubes allow patients who are unable to tolerate-cuff deflation to achieve phonation. Our experience with talking tracheostomy tubes suggests that clinicians should consider their use for patients who cannot tolerate cuff deflation.

Copyright © 2014 by Plural Publishing, Inc. Address correspondence to: Vinciya Pandian, Tracheostomy Nurse Practitioner, Percutaneous Tracheostomy Service, The Johns Hopkins Hospital, 600 N. Wolfe Street, Meyer 8-140, Baltimore, MD 21287. [email protected].

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Keywords


mechanically ventilation; speech; communication; talking tracheostomy tube; and quality of life

INTRODUCTION Verbal communication greatly affects people’s autonomy and is directly related to how they perceive their quality of life (Hess, 2005). The need for effective communication is heightened during critical illness. Critically ill patients requiring mechanical ventilation often need an endotracheal tube or a tracheostomy tube. When a patient is intubated, communication is often accomplished through facial expressions, gestures, and/or writing, depending on the person’s neurological status and sedation level (Batty, 2009). However, these simple modes of communication are not always effective and can often result in frustration for the patient (Patak et al., 2006).


A benefit of tracheostomy over an endotracheal tube is that it may facilitate the ability to communicate by mouthing words. Additionally, when a person receives a tracheostomy tube, several methods used to elicit phonation can be utilized, including the use of a one-way speaking valve, leak speech, and digital occlusion. All of these methods require toleration of cuff deflation (Astrachan, Kirchner, & Goodwin, Jr., 1988; Batty, 2009; Hess, 2005; Nomori, 2004). Unfortunately, some critically ill mechanically ventilated patients cannot tolerate cuff deflation despite their ability to maintain arousal and to initiate meaningful communication. Uniquely designed tracheostomy tubes are available that enable speech and do not require cuff deflation. These “talking tracheostomy tubes” are rarely used because of a general lack of awareness among care providers. The purpose of this article is to: (1) describe the types of talking tracheostomy tubes available, (2) present four case studies of critically ill patients who benefited from these tubes, (3) discuss their advantages and disadvantages, propose patient selection criteria, and (4) provide practical recommendations for medical care providers.

TYPES OF TALKING TRACHEOSTOMY TUBES (NOT REQUIRING CUFF NIH-PA Author Manuscript

DEFLATION) Shiley® Cuffed Fenestrated Tracheostomy Tubes Shiley® Cuffed Fenestrated Tracheostomy Tubes (Covidien, Boulder, CO) have an opening on the superior aspect of the tube that allows airflow to the upper airway. If a patient requires mechanical ventilation, large volumes of air are needed to compensate for the loss of air via the fenestrated port. Tracheal mucosa may get entrained into the fenestration, increasing the risk for granulation tissue formation and tracheal stenosis. Blom® Tracheostomy Tube The Blom® Tracheostomy Tube (Pulmodyne, Indianapolis, IN) has a thin polyvinyl chloride cuff and a fenestration. It can be used with either a standard nonspeech cannula or a speech cannula. The speech cannula will allow air to flow to the upper airway through a

J Med Speech Lang Pathol. Author manuscript; available in PMC 2014 November 24.

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strategically placed fenestration located above the cuff. The inflated cuff prevents the fenestration from contacting the tracheal mucosa. Inspiratory pressure causes the valve flap at the level of the fenestration to close so that all inspiratory air goes to the lungs. During exhalation, expiratory pressure allows opening of the fenestration to permit exhaled air to flow to the upper airway to achieve phonation. One of the benefits of this talking tracheostomy tube is that it provides a hands-free means of communication. Portex® Trach-Talk™ Blue Line® Tracheostomy Tubes The Portex® Trach-Talk™ Blue Line® Tracheostomy Tubes (Smiths Medical, Dublin, OH) have an additional lumen above the cuff through which air can be administered to facilitate verbal communication. One particular issue that we have encountered with this type of tracheostomy tube is that the thumb port cannot be detached for suctioning and clearing out secretions trapped in the lumen. If speech lumen becomes clogged, the whole tracheostomy tube would need to be replaced to have a functional tube for speech. The inner cannulas are corrugated, potentially increasing the risk of mucus plugging and difficulty in clearing secretions. In addition, because these inner cannulas are not reusable, health-related costs for patients and families can be higher.


Bivona® Mid-Range Aire-Cuf® and Fome-Cuf® Tracheostomy Tubes with Talk Attachment Bivona® Mid-Range Aire-Cuf® and Fome-Cuf® Tracheostomy Tubes with Talk Attachment (Smiths Medical, Dublin, OH) include a lumen above the cuff to direct compressed air through the upper airway to achieve vocalization. Similar to the Portex® Trach-Talk™ Blue Line® Tracheostomy Tubes, these tracheostomy tubes’ speech lumen can also become clogged because the thumb port is not detachable for cleaning or suction use. The air cuff can later be deflated for transitioning to speaking valve use. It is important to note, however, that the foam cuff cannot be deflated for use with a speaking valve. Portex® Blue Line ultra® Suctionaid (BLuSA) Tracheostomy Tubes The BLUSA cuffed tracheostomy tube (Smith Medical, Dublin, OH) (Figure 1) features an additional lumen located above the cuff that can be dedicated for suction and/or speech. This particular tracheostomy tube was used in the four case studies reported here. The BLUSA has a 15-mm hub for transition to a speaking valve if the patient progresses to cuff deflation.


Table 1 lists the distinguishing characteristics of the various talking tracheostomy tubes.

METHODS After obtaining Institutional Review Board approval, we performed a retrospective analysis of prospectively collected data. Included in the study were patients who had received a tracheostomy in 2010 at an academic tertiary care center. These patients received standardized pre- and postoperative care from a dedicated tracheostomy team composed of credentialed operators, anesthesiologists, a dedicated tracheostomy nurse practitioner, nurses, respiratory therapists, and speech-language pathologists (Pandian, Nguyen, Mirski, & Bhatti, 2008; Pandian et al., 2011; Pandian et al., 2012). Case studies of four patients who received a BLUSA cuffed tracheostomy tube are presented to provide an understanding of


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the role of special tracheostomy tubes in patients who cannot tolerate cuff deflation. We used Stata 11.0 software to analyze our data. Percentages are reported for all variables.


RESULTS Figure 2 gives a statistical overview of the 220 patients who received a tracheostomy in 2010. As shown, 164 (74.55%) received a percutaneous tracheostomy and 56 (25.45%) received an open tracheostomy. Speech-language pathologists (SLP) were consulted on 113 (68.90%) patients who received a percutaneous tracheostomy. Of the patients who were evaluated by SLP, 74 were mechanically ventilated at the time of that consult. Among these mechanically ventilated patients, 29 demonstrated tolerance of the in-line speaking valve during the first trial, and 6 required additional follow-up sessions to achieve tolerance of the speaking valve. Four mechanically ventilated patients did not pass the in-line speaking valve trial and received a BLUSA tracheostomy tube for speech.

CASE STUDIES


To elaborate on both the benefits of and issues arising from the use of BLUSA tubes, we report our experience with these four patients who succeeded in verbal communication. Case 1


A 45-year-old Indian man, who received bilateral orthoptic lung transplant for progressive interstitial lung disease, developed respiratory failure secondary to diaphragmatic paralysis and pneumonia. A tracheostomy was performed for chronic ventilator dependence. He was unable to tolerate cuff deflation while receiving mechanical ventilation as he had a high level of anxiety despite extensive education about the process involved with cuff deflation and Passy Muir speaking valve use, music therapy, and pharmacologic management. A size 8.0 BLUSA was placed, and the patient was able to achieve a hoarse vocal quality on 5 liters of air initially. However, during a later session, he began to develop a strained vocal quality in an attempt to control airflow by tensing his vocal folds. Vocal function exercises were effective in reducing the strained vocal quality. Changing from an 8.0-mm to a 9.0-mm BLUSA resulted in a better seal around the cuff to maintain better intrathoracic pressures. With the 9.0-mm BLUSA, he was able to phonate with only 4 liters of air. He used the BLUSA as his primary means of communication with family and staff for months until he passed away. Using a BLUSA allowed the patient to achieve meaningful communication, while decreasing the anxiety associated with cuff deflation. Case 2 A 54-year-old Caucasian man presented with a history of progressive lymphoproliferative disorder status post several rounds of chemotherapy and bone marrow transplant. His disease course was complicated by severe graft versus host disease, and he was admitted for worsening pulmonary infiltrates. Despite broad spectrum antibiotic and antifungal therapy, he progressed to acute respiratory distress syndrome and required intubation. He eventually received a tracheostomy for prolonged ventilator dependence and was unable to tolerate cuff deflation for a speaking valve. He had a life partner who took care of him around the clock. They wanted to communicate during the patient’s terminal days. The tracheostomy team J Med Speech Lang Pathol. Author manuscript; available in PMC 2014 November 24.

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placed a BLUSA for verbal communication. This patient was not strong enough to raise his arm to occlude the thumb port. However, his partner was very helpful and occluded the thumb port for him to communicate. Although the patient was not able to carry on lengthy conversations, the BLUSA promoted his quality of life by allowing him to express his basic needs and emotions such as pain, anxiety, thirst, and other discomforts. Case 3


A 25-year-old Caucasian woman who was diagnosed with type 2 neurofibromatosis at age 14 and underwent multiple bilateral vestibular schwannoma resections with residual left facial weakness and deafness in the left ear presented after a suboccipital craniotomy that was complicated by sacrifice of the right facial nerve, right vocal fold paralysis, severe oropharyngeal dysphagia, severe gastroesophageal reflux disease, and new onset deafness in the right ear. After weaning from the mechanical ventilator failed, a tracheostomy tube was placed. A 4.0 tracheostomy tube was eventually was chosen because of her anatomy and inability to achieve phonation with a 6.0 cuffed tracheostomy tube. Although was able to vocalize with the use of a speaking valve, achieving efficient ventilation and suctioning were difficult with the smaller tracheostomy tube. She could not hear her own voice, but she was motivated to achieve phonation for ease of communication with staff, family, and her boyfriend. The tracheostomy team placed a BLUSA to enable verbal communication.


Soon after the placement of the BLUSA, she weaned to requiring only nocturnal ventilator support. During the daytime when she could tolerate cuff deflation, she was unable to achieve adequate phonation with the BLUSA secondary to air leakage around the stoma despite trying multiple airflow settings. As her condition improved, she was able to achieve hoarse vocal quality with cuff deflation and digital occlusion, which had not been possible with a traditional tracheostomy tube of similar size. The BLUSA tubes have a smaller outer diameter and larger inner diameter than do our institution’s standard Shiley tracheostomy tubes. The larger inner diameter permits adequate ventilation and suctioning, whereas the smaller outer diameter allows upper airway airflow with digital occlusion and speaking valve use. She was diagnosed with severe flaccid dysarthria with approximately 10% intelligibility. She continued to use digital occlusion intermittently to produce 1- or 2-word utterances with poor intelligibility while tolerating cuff deflation. A month later, she stopped using digital occlusion for speech, preferring text messaging and typing for communication. She was diagnosed with severe depression. Augmentative alternative communication assessment was recommended. Over the course of time, the BLUSA was no longer suitable for her because of deficits in cranial nerves V and VII that impaired articulation, true vocal fold motion impairment, deafness, depression, and decreased motivation. Case 4 A 40-year-old African American man with amyotrophic lateral sclerosis presented for an elective tracheostomy for prolonged mechanical ventilation. A 6.0 cuffed tracheostomy tube was placed. After tracheostomy, he was evaluated for inline speaking valve tolerance but had increased peak inspiratory pressures and failed speaking valve trials. His speech was characterized as moderate spastic-flaccid dysarthria. Intelligibility was better with airflow to the upper airway than with lip reading alone, and therefore a BLUSA was placed. Three


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liters of air were administered via the blue line. He was able to achieve intelligible phonation with the assistance of a communication partner (speech-language pathologist or nursing aid). The communication partner had to occlude the thumb port for him as he had upper extremity weakness and was unable to occlude it himself. Although the device enabled the patient to speak, he had thick secretions, and suction catheters were too large for the BLUSA’s inner cannula, making suctioning difficult. Change to an 8.0 BLUSA improved the ease of suctioning and decreased airflow requirement from 3 to 2 liters. In addition, he reported increased comfort. However, over the course of time, he demonstrated trapping of air below the vocal folds because of vocal fold spasms. Vocal function exercises were beneficial in reducing laryngeal spasticity and improving vocal quality. He was able to successfully use the BLUSA for short conversations with family and friends while he continued to use his augmented communication device (DynaVox Ey-eMax™, DynaVox Mayer-Johnson, Wollaston, UK) for speaking engagements and work-related tasks.

DISCUSSION


Patients who have high positive end-expiratory pressure requirements on the ventilator are at risk for atelectasis (collapse of alveoli), arterial-alveolar shunting (good blood supply but poor ventilation), and desaturation after sudden loss of the end-expiratory pressure upon cuff deflation. Although talking tracheostomy tubes can help with phonation in patients who are unable to tolerate cuff deflation while on the ventilator, they are rarely used, perhaps because providers are unaware of their benefits. Few reports have explored the use of BLUSA tracheostomy tubes for verbal communication (Husain, Gatward, & Harris, 2011; Leder & Traquina, 1989; Safar & Grenvik, 1975), likely because the device was initially designed for suctioning of subglottic secretions, unlike other talking tracheostomy tubes, to decrease the incidence of ventilator-associated pneumonias (Coffman, Rees, Sievers, & Belafsky, 2008; Dezfulian et al., 2005; Lacherade et al., 2010). To our knowledge, this is the first paper to describe the use of BLUSA to improve speech. We have found that the BLUSA has numerous advantages over traditional talking tracheostomy tubes: (1) the speech lumen diameter is larger, (2) the inner cannula is not corrugated, and (3) the thumb port can be disconnected and the speech lumen can be flushed with saline for patency.


Advantages No Interruption of the Function of the Mechanical Ventilator—As cuff deflation and changes to ventilator settings are not required, the volume of air entering the lungs and exiting will remain similar to that of a person not using a speaking valve. BLUSA tracheostomy tubes have a unique cuff texture that is supposed to allow a better seal in the trachea, resulting in continuous and accurate monitoring of tidal volumes (Safar & Grenvik, 1975). Airway Hygiene—Generally, airway hygiene is better with tracheostomy than endotracheal tubes. In addition, the BLUSA allows intermittent suctioning of secretions in the subglottic region via the blue line. This suction, in turn, can prevent flow of aspirated secretions into the lungs and decreases the risk for pneumonitis or ventilator-associated J Med Speech Lang Pathol. Author manuscript; available in PMC 2014 November 24.

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pneumonia. This benefit is especially important for patients who have poor glottic function and cannot protect their airway from oropharyngeal secretions.


Patient Safety—Patients who use inline speaking valves while they are mechanically ventilated have limited time for communication given that monitoring by experienced staff is necessary for safety. However, with BLUSA tubes, if patients are able, they can occlude their thumb port and communicate at their convenience even in the absence of experienced staff. Patients do not have to wait for the medical staff to deflate the cuff and provide monitoring. Even if they are unable to occlude the thumb port, their communication partner (family member/friend) can occlude it for them without waiting for medical staff. Increased Inner Diameter While Outer Diameter Remains Small—A decrease in inner diameter of the tracheostomy tube can result in large increases in airway resistance. Compared to most of the commercially available standard tracheostomy tubes, the inner diameter of the BLUSA is larger while the outer diameter is similar. This design prevents the increase in airway resistance associated with tracheostomy tubes that have a smaller inner diameter. The design also promotes ease of suctioning without having to increase the outer diameter of the tracheostomy tube.


Comfort—The cuff is made of plasticized poly-vinyl chloride using a Soft Seal® cuff design with reduced bulk that is more compliant and decreases the amount of pressure it applies on the tracheal wall while maintaining good seal within the trachea compared to traditional commercially available tracheostomy tube cuffs (Young & Blunt, 1999). This construction can decrease the risk for tracheal wall ischemia and/or granulation tissue formation. Ease of Use—Once initial evaluation is completed, patients using BLUSA do not require frequent follow-up to evaluate tolerance because of the creation of two separate circuits— one for speech and one for ventilation. BLUSA does not require extensive training for staff, patients, or family as is common with high tech augmentative communication devices or inline speaking valves.


Decrease Anxiety—Up to 35% of critically ill individuals undergoing prolonged mechanical ventilation experience increased anxiety (Hofhuis et al., 2008; Li & Puntillo, 2004; Samuelson, 2011; Treggiari et al., 2009). Patients’ levels of anxiety can be lessened if they are able to adequately communicate with their care-givers, family, and friends (Batty, 2009; Lindgren & Ames, 2005). Patients using BLUSA are able to communicate at their convenience, thereby decreasing anxiety as shown in Case 1. Communication can also provide a sense of autonomy in that these patients can participate in their ICU care decisionmaking process. Improvement of Quality of Life—Being able to verbally communicate can improve how a person perceives his or her quality of life (Hess, 2005).


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Potential Problems and Practical Solutions


Speech Lumen Occlusion—Occasionally, the speech lumen can become occluded with secretions that are pooled in the subglottic region above the tracheostomy cuff, thereby preventing the airflow required for phonation. The occlusion can be remedied by slowly aspirating with a 20-cc syringe for as long as necessary to remove subglottic secretions. If resistance is met on aspiration, it may be necessary to flush/irrigate the line with air or sterile normal saline (5 mL–10 mL) via 20-cc syringe, and immediately aspirate the line to clear. It is normal for some irrigation fluid to exit the stoma area. If the occluded line cannot be cleared, it may be necessary to replace the BLUSA. In addition, we avoid placing a BLUSA as the initial tracheostomy tube in order to prevent bloody secretions from clogging the speech port. The BLU-SA can be placed during the first tracheostomy tube change, once the stoma has formed.


Self-Occlusion—Patients who have upper extremity weakness or discoordination may not be able to independently occlude the thumb port to facilitate phonation. Usually, when a patient communicates, there will be someone in the room to whom the patient will be talking (communication partner). The communication partner (staff, family, caregiver, or significant other) must be educated on assisting the patient with occlusion of the thumb port. Signs/ educational pamphlets may be placed in the room to educate the communication partner on this task. Vocal Cord Injury—There is a potential risk for vocal fold injury caused by dry air moving up through the airway through the vocal folds. Attaching a humidifier to the air that is administered via the speech lumen can alleviate this problem. Hyperadduction of the vocal folds in response to high airflow is also a risk. It is important to identify the minimum airflow requirement to elicit phonation to avoid hyperadduction. Tippett recommends the use of 4 to 7 liters of air to achieve phonation (Tippett & Vogelman, 2000). In our experience, in persons of small stature, 2 liters of air may be sufficient. It is also crucial that the air/oxygen is not administered via the speech lumen if the patient has an upper airway obstruction as the air/oxygen supply may result in pressure building up in the subglottic space (Smith Medical, 2007).


Poor Vocal Quality—Sometimes patients can achieve phonation but their vocal quality may not be optimal, perhaps because of dry airway, hyperadduction, underlying vocal fold pathology, or upper airway obstruction. It is vital to assess the integrity of the vocal folds or upper airway patency and consult otolaryngologists to perform upper airway laryngoscopy to identify any underlying pathology. Poor Tubing Connection—In our experience, achieving a secure connection between the thumb port and the oxygen tubing is often difficult. Extra effort by pushing and twisting may be needed to ensure a tight and secure connection. Some clinicians use adhesive tape to secure the connection. It is necessary to assess the thumb port frequently to monitor the connection.


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Disposition Issue—Many home health care agencies do not provide medical air that is required for phonation with the BLUSA. Oxygen can be used instead to enable speech with a BLUSA. Abdominal Distention—The mechanical ventilator administers breaths without impacting the speech circuit; however, the amount of air administered via the speech lumen potentially could be swallowed when the mouth is closed and cause abdominal distention. It is important to make sure airflow is turned off when the patient is not pursuing communication. If medical air is administered continuously, it is important to ensure that the thumb port remains unoccluded. Line Misidentification—Given that BLUSA is rarely used, clinicians may not be aware of the unique parts of a talking tracheostomy tube. As a result, they might have difficulty differentiating between the pilot balloon and the speech lumen. We recommend clearly labeling the pilot balloon and the speech lumen to avoid medical error.


Subcutaneous Emphysema—According to the manufacturer’s guidelines, the speech lumen should never be used for speech in a freshly formed stoma as the air intended for speech may leak through the stoma preventing speech but causing subcutaneous emphysema (Smith Medical, 2007). It is most likely safer to place a BLUSA for speech during the first tracheostomy tube change rather than the initial placement. Selection of Patients for BLuSA On the basis of our experience, we propose that patients who fit the following criteria are eligible for a BLUSA.


1.

Patients who require prolonged mechanical ventilation but cannot tolerate cuff deflation.

2.

Patients who are awake, alert, and attempting to communicate.

3.

Patients who are able to manipulate the thumb port or have a communication partner who is able to assist with use of the device.

4.

Patients with sufficient motor speech and language capabilities to produce functional communication.

5.

Patients without upper airway obstruction.

6.

Patients with an established stoma.

Role of the Speech-Language Pathologist The speech-language pathologist (SLP) plays an important role on the interdisciplinary team, serving as an advocate for both the communication and swallowing needs of a patient with a tracheostomy. As the level of care for this patient population has evolved and expanded beyond the acute medical setting to rehabilitation and long-term care facilities as well as the community setting, the SLP must obtain the necessary training to provide services in this area. The American Speech-Language-Hearing Association has identified


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clear guidelines, knowledge, and skills to achieve proficiency in management of this population (American Speech-Language-Hearing Association, 1993).


The evaluation of communication for a patient with a tracheostomy tube typically begins with determining a patient’s candidacy for speaking valve use. If a patient cannot tolerate a traditional speaking valve, the SLP may assist with troubleshooting and identification of alternate communication options, including the placement of a talking tracheostomy tube. The SLP often initiates discussion with the medical team about a patient’s prognosis and plan of care before suggesting a talking tracheostomy tube. There must be consideration of a patient’s weaning potential, cognition, and physical and psychosocial issues. The selection criteria proposed in this paper may be used as a reference. Once the talking tracheostomy tube is placed, the SLP will make recommendations for optimal airflow settings for voicing and provide education to the patient, family, and team to ensure proficient use of the new tracheostomy. Vocal function exercises will be needed by many patients as part of their treatment. Evaluation and treatment for this patient population is dynamic, and the SLP provides ongoing support for troubleshooting barriers to communication that may arise.


CONCLUSION Talking tracheostomy tubes enable phonation in patients who are unable to tolerate cuff deflation. To our knowledge, this paper is the first to discuss the use of BLUSA for verbal communication. Selection criteria proposed in this paper will enable clinicians to identify appropriate patients. Although we are limited in how far we can extrapolate from our 4 case studies, our findings suggest the value of a wider use of BLUSA and support the need for further research into its benefits for certain patients. Prospective studies comparing the different types of talking tracheostomy tubes incorporating a larger sample size are required to further explore the benefits of these tracheostomy tubes. Our experience with BLUSA suggests that clinicians should consider the use of talking tracheostomy tubes for patients who cannot tolerate cuff deflation.

References


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NIH-PA Author Manuscript Figure 1.

Portex® Blue Line Ultra® Suctionaid (BLUSA) tracheostomy tube.

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NIH-PA Author Manuscript NIH-PA Author Manuscript

Figure 2.

Tracheostomy statistics.

NIH-PA Author Manuscript J Med Speech Lang Pathol. Author manuscript; available in PMC 2014 November 24.

NIH-PA Author Manuscript x x x

Portex® Trach-Talk™ Blue Line®

Shiley® Cuffed Fenestrated

x

x

Blom® Tracheostomy Tube

Bivona® Fome-Cuf®

Bivona® Mid-Range Aire-Cuf®

Portex® Blue Line ultra® Suctionaid (BLuSA)

Deflatable Air Cuff

x

Fome Cuff

x

x

x

x

Lumen above the cuff

x

x

Suction above the cuff


Characteristics of Talking Tracheostomy Tubes

x

Detachable thumb port

x

x

Fenestration

x

x

x

Inner cannula


TABLE 1

x

Require air for speech

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Communication of mechanically ventilated patients in intensive care units.

The number of mechanically ventilated ICU patients meeting communication criteria.

Myopathic characteristics in septic mechanically ventilated patients.

Conservative oxygen therapy in mechanically ventilated patients.

Ofloxacin pharmacokinetics in mechanically ventilated patients.

Music interventions for mechanically ventilated patients.

Cardiopulmonary resuscitation among mechanically ventilated patients.

Partitioning of respiratory mechanics in mechanically ventilated patients.

Severe and early quadriceps weakness in mechanically ventilated patients.

Microbial profiling of dental plaque from mechanically ventilated patients.

Management and outcome of mechanically ventilated patients after cardiac arrest.

The electrolarynx improves communication in a selected group of mechanically ventilated critically ill patients: a feasibility study.

Cost comparison of mechanically ventilated patients across the age span.

A patient-specific airway branching model for mechanically ventilated patients.

Hospital Readmission Rates Among Mechanically Ventilated Patients With Stroke.

Postoperative pneumonia following cardiac surgery in non-ventilated patients versus mechanically ventilated patients: is there any difference?

BIS monitoring in sedated, mechanically ventilated patients: right tool in the wrong patients? A meta-analysis.

The use of tracheostomy speaking valves in mechanically ventilated patients results in improved communication and does not prolong ventilation time in cardiothoracic intensive care unit patients.

Two Cases of Pneumatoceles in Mechanically Ventilated Infants.

Neonatal complications of extreme prematurity in mechanically ventilated infants.

Gastro-oesophageal reflux in mechanically ventilated preterm infants.

Carbon dioxide elimination and oxygen consumption in mechanically ventilated children.

Trends in Tracheostomy for Mechanically Ventilated Patients in the United States, 1993-2012.

Lung stress and strain calculations in mechanically ventilated patients in the intensive care unit.