Critical Care Medicine: June 2016 -
Volume 44 - Issue 6 - p 1075–1081
Freeman-Sanderson, A L et al
Objectives: A cuffed tracheostomy tube facilitates prolonged
mechanical ventilation and weaning but usually leads to prolonged
voicelessness, which can be one of the most negative experiences of
hospitalization. No randomized trials have examined the effects of targeted
early communication intervention for the restoration of voice in ventilated
tracheostomy patients in the ICU. Design: A prospective randomized clinical
trial. Setting: The trial was conducted in the ICU of an urban tertiary level
hospital. Patients: Thirty adult participants enrolled, with 15 randomly
allocated to the intervention and control groups. Interventions: The early
intervention group received early cuff deflation and insertion of an in-line
speaking valve during mechanical ventilation. The control group received
standard cuff deflation and a speaking valve during self-ventilation. A
speech-language pathologist provided all treatments. Measurements and Main
Results: The primary outcome measure was time from tracheostomy insertion to
phonation. Early intervention significantly hastened return to phonation (median
difference = 11 d; hazard ratio = 3.66; 95% CI, 1.54–8.68) with no significant
effect on duration of tracheostomy cannulation (hazard ratio = 1.40; 95% CI,
0.65–3.03), duration of mechanical ventilation in days from tracheostomy
insertion (hazard ratio = 1.19; 95% CI, 0.58–2.51), length of stay in ICU
(hazard ratio = 1.16; 95% CI, 0.54–2.52), or time to return to oral intake
(hazard ratio = 2.35; 95% CI, 0.79–6.98). Adverse events were low and equal in
both groups. There was no significant change in measures of quality of life.
Conclusions: Focused early intervention for communication during mechanical
ventilation allows the restoration of phonation significantly sooner than
standard treatment, with no increase in complications in a small patient cohort.
Although these results are favorable, further research is needed to determine
whether the effects on any of the secondary outcomes are statistically
significant and clinically important.
