Objective: The primary objective of our study was to determine the quality of life (QOL) using a talking tracheostomy tube. Methods: Randomized clinical trial (NCT2018562). Adult intensive care unit patients who were mechanically ventilated, awake, alert, attempting to communicate, English-speaking, and could not tolerate one-way speaking valve were included. Intervention comprised a Blue Line Ultra Suctionaid (BLUSA) talking tracheostomy tube (Smiths Medical, Dublin, OH, US). Outcome measures included QOL scores measured using Quality of Life in Mechanically Ventilated Patients (QOL-MV) and Voice-Related Quality of Life (V-RQOL), Speech Intelligibility Test (SIT) scores, independence, and satisfaction.Results: The change in V-RQOL scores from pre-to postintervention was higher among patients using a BLUSA (Smiths Medical) compared to those who did not (P = 0.001). The QOL-MV scores from pre-to postintervention were significantly higher among patients who used a BLUSA (Smiths Medical) compared to patients who did not use BLUSA (Smiths Medical) or a one-way speaking valve (P = 0.04). SIT scores decreased by 6.4 points for each 1-point increase in their Sequential Organ Failure Assessment scores (P = 0.04). The overall QOL-MV scores correlated moderately with the overall V-RQOL scores (correlation coefficient = 0.59). Cronbach alpha score for overall QOL-MV was 0.71. Seventy-three percent of the 22 intervention patients reported the ability to use the BLUSA (Smiths Medical) with some level of independence, whereas 41% reported some level of satisfaction with the use of BLUSA (Smiths Medical). The lengths of stay was longer in the intervention group.Conclusion: Our study suggests that BLUSA (Smiths Medical) talking tracheostomy tube improves patient-reported QOL in mechanically ventilated patients with a tracheostomy who cannot tolerate cuff deflation.

Learning Objectives: Accumulating evidence implicates the role of systemic inflammation in the pathogenesis of pulmonary arterial hypertension (PAH). C -reactive protein (CRP) is an established marker of inflammation that is active in the physiopathology of the vascular wall. It is hypothesized that the proinflammatory properties of CRP contribute to pulmonary vascular remodeling via modulation of the nuclear factor-kappa B pathway. The association between CRP and PAH is unclear. We conducted a meta-analysis to evaluate the relationship between serum CRP levels and PAH. Methods: We searched MEDLINE, CINAHL and COCHRANE databases for studies reporting serum CRP levels in the PAH and non PAH study population. We included case controls, cohort and cross-sectional studies. We calculated the weighted standardized mean difference (SMD) in serum CRP levels between the PAH and control groups. Results: Our search strategy yielded 124 articles. We included eight studies enrolling 861 participants. PAH was diagnosed either by doppler echocardiography (52%) or right heart catheterization (48%). The median age of the PAH group was 55 yr. (IQR 41 -61) vs 48 yr. in the control group. The median body mass index in the PAH group was 25.6 kg/m2 (IQR 24.7-26.4) vs 25.9 kg/m2 (IQR 25.1-27.3) in the control group. The unweighted median serum CRP levels in the PAH group were 6.75 mg/l (IQR 3.9-12.5) vs 3.15 mg/l (IQR 2 -6.9) in the control group. The SMD of CRP level was 0.75 (95% CI 0.31 -1.18) p<0.001 comparing the PAH group vs the control group. Conclusions: An elevated serum CRP level is significantly associated with the presence of PAH. Given the significance of elevated CRP levels in PAH, directing further studies in understanding the role or CRP in the etio-pathogenesis of PAH would help determine newer modalities of therapeutic options and prognostic indicators.