A Multidisciplinary Approach to Verbal Communication Interventions for Mechanically Ventilated Adults With a Tracheostomy

Abstract

There is developing evidence with regard to the feasibility, utility, and safety of verbal communication interventions with patients with tracheostomy who are invasively ventilated. In the past 2 decades, research efforts have focused on establishing evidence for communication interventions, including introducing an intentional leak into the ventilatory circuit such as with a fenestrated tube, leak speech or ventilator-adjusted leak speech, the use of a one-way valve in-line with the ventilator, and above cuff vocalization. This narrative review describes the benefits of a multi-disciplinary approach, summarizes verbal communication interventions, and provides guidance on the indications, contraindications and considerations for patient selection. Our clinical procedures based on collective clinical experience are shared. A multidisciplinary team approach enables holistic management across acuity, ventilation, airway, communication, and swallowing parameters. This collaborative approach is recommended to maximize the chance of successful opportunities for patients to communicate safely and effectively.

Keywords: clinical procedures; communication; multidisciplinary; speech; tracheostomy; ventilation; voice.

Figure 1.

Above cuff vocalization.

Figure 2.

A: Ventilator-adjusted leak speech with cuff deflation or cuffless tube. B: Ventilator-adjusted leak speech with a fenestrated tube.

Figure 3.

Voicing threshold.

Figure 4.

One-way valve in-line with the ventilator.