Above cuff vocalisation: A novel technique for communication in the ventilator-dependent tracheostomy patient

McGrath, Brendan A.; Lynch, James C.; Wilson, Mark; Nicholson, Leanne; Wallace, Sarah

doi:10.1177/1751143715607549

Cited by 58 publications

(72 citation statements)

References 32 publications

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“… 52 Careful selection and use of tracheostomy tubes, fenestrations, cuff management and novel communication techniques can have a significant effect on speech facilitation and a positive impact on patient anxiety levels. 52 , 53 An inflated tracheostomy tube cuff excludes the larynx and upper airway from normal airflow patterns, and one of the best methods of facilitating communication is to deflate the cuff as soon as possible. 19 Cuff deflation can add a significant work of breathing to the patient however, especially if upper airway gas flow is augmented by the use of one-way speaking valves.…”

Section: Roles Of the Multidisciplinary Tracheostomy Teammentioning

confidence: 99%

Role of the multidisciplinary team in the care of the tracheostomy patient

Bonvento¹,

Wallace²,

Lynch³

et al. 2017

JMDH

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Tracheostomies are used to provide artificial airways for increasingly complex patients for a variety of indications. Patients and their families are dependent on knowledgeable multidisciplinary staff, including medical, nursing, respiratory physiotherapy and speech and language therapy staff, dieticians and psychologists, from a wide range of specialty backgrounds. There is increasing evidence that coordinated tracheostomy multidisciplinary teams can influence the safety and quality of care for patients and their families. This article reviews the roles of these team members and highlights the potential for improvements in care.

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Section: Roles Of the Multidisciplinary Tracheostomy Teammentioning

confidence: 99%

Role of the multidisciplinary team in the care of the tracheostomy patient

Bonvento¹,

Wallace²,

Lynch³

et al. 2017

JMDH

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“…At the lead site, this increased to 100% by month 3 and was maintained throughout. Successful SLT case studies concerning early use of one-way tracheostomy speaking valves to facilitate early vocalisation were highlighted to relevant staff during educational sessions 15 . Monthly analysis of the dataset for percutaneous tracheostomies showed non-significant trend toward earlier speaking valve use (median slope=-0.17, -0.83 to 0.4).…”

Section: Resultsmentioning

confidence: 99%

Evaluating the quality improvement impact of the Global Tracheostomy Collaborative in four diverse NHS hospitals

McGrath¹,

Lynch²,

Bonvento³

et al. 2017

BMJ Qual Improv Report

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Tracheostomies are predominantly used in Head & Neck Surgery and the critically ill. The needs of these complex patients frequently cross traditional speciality working boundaries and locations and any resulting airway problems can rapidly lead to significant harm. The Global Tracheostomy Collaborative (GTC) was formed in 2012 with the aim of bringing together international expertise in tracheostomy care in order to bring about rapid adoption of best practices and to improve the quality and safety of care to this vulnerable group.The primary aim of this project was to improve the safety and quality of care delivered to adult patients with new or existing tracheostomies. We implemented changes guided by the GTC using multiple PDSA cycles over a 12-month period. Interventions were across three themes: educational, patient-centred (earlier vocalisation and enteral intake) and organisational. We hypothesised that systematic healthcare improvements would reduce the severity of harm resulting from tracheostomy-related safety incidents and improve surrogate markers of the quality of patient-centred care. Furthermore, we hypothesised that raising the quality and safety of healthcare services would lead to more efficient care, measured by earlier tracheostomy decannulation times and reduced hospital lengths of stay.This Quality Improvement project implemented the GTC into four diverse NHS Trusts in Greater Manchester. Key drivers implemented included multidisciplinary tracheostomy steering groups, ward rounds and bedside teams, standardisation of tracheostomy protocols, staff education and meaningful involvement of patient and family. Surrogates for the quality and safety of care were captured for all patients using a bespoke database.Implementing the GTC into four NHS Trusts rapidly and positively impacted on patient safety metrics and surrogates for the quality of care delivered. It is likely that the comprehensive resources of the GTC will be of benefit to other NHS hospitals and indeed other healthcare systems around the world.

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“…Our preliminary study of four cases suggested feasibility of using a BLUSA (Smiths Medical) for phonation . McGrath et al reported similar successes with phonation using BLUSA (Smiths Medical) among five patients . Mitate et al discussed the use of a talking tracheostomy tube and modified mouthstick stylus in a ventilator‐dependent patient with spinal cord injury .…”

Section: Discussionmentioning

confidence: 96%

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

et al. 2019

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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.

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Above cuff vocalisation: A novel technique for communication in the ventilator-dependent tracheostomy patient

Cited by 58 publications

References 32 publications

Role of the multidisciplinary team in the care of the tracheostomy patient

Role of the multidisciplinary team in the care of the tracheostomy patient

Evaluating the quality improvement impact of the Global Tracheostomy Collaborative in four diverse NHS hospitals

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

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