Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 May;68(5):680-691.
doi: 10.4187/respcare.10511.

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

Charissa J Zaga  1   2   3 , Caroline Chao  3   4   5   6 , Tanis Cameron  4 , Jacqueline Ross  6   7 , Linda Rautela  3   5   6 , Thomas C Rollinson  3   6   8 , Emma Marchingo  9 , Prudence A Gregson  4 , Stephen Warrillow  10   11 , Naomi E Atkins  3   4   5 , Mark E Howard  3   5   12   13
Affiliations
Review

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

Charissa J Zaga et al. Respir Care. 2023 May.

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.

PubMed Disclaimer

Conflict of interest statement

The authors have disclosed no conflicts of interest.

Figures

Figure 1.
Figure 1.
Above cuff vocalization.
Figure 2.
Figure 2.
A: Ventilator-adjusted leak speech with cuff deflation or cuffless tube. B: Ventilator-adjusted leak speech with a fenestrated tube.
Figure 3.
Figure 3.
Voicing threshold.
Figure 4.
Figure 4.
One-way valve in-line with the ventilator.
See this image and copyright information in PMC

References

    1. Hafsteindottir T. Patient's experiences of communication during the respirator treatment period. Intensive Crit Care Nurs 1996;12(5):261–271. - PubMed
    1. Zengin N, Oren B, Ustundag H. The relationship between stressors and intensive care unit experiences. Nurs Crit Care 2020;25(2):109–116. - PubMed
    1. Tembo A, Higgins I, Parker V. The experience of communication difficulties in critically ill patients in and beyond intensive care: findings from a larger phenomenological study. Intensive Crit Care Nurs 2015;31(3):171–178. - PubMed
    1. Manzano J, Lubillo S, Henriquez D, Martin J, Perez M, Wilson DJ. Verbal communication of ventilator-dependent patients. Crit Care Med 1993;21(4):512–517. - PubMed
    1. Heffner JE. Management of the chronically ventilated patient with a tracheostomy. Chron Respir Dis 2005;2(3):151–161. - PubMed

LinkOut - more resources