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
. 2024;1(1):26-41.
doi: 10.62905/001c.115440. Epub 2024 Mar 31.

Enhancing Communication in Critically Ill Patients with a Tracheostomy: A Systematic Review of Evidence-Based Interventions and Outcomes

Mary N Gentile  1 , Annalise D Irvine  1 , Annamarie M King  2 , Achsha S Hembrom  3 , Keven S Guruswamy  3 , Nina E Palivela  3 , Nicole Langton-Frost  1 , Colleen R McElroy  1 , Vinciya Pandian  3
Affiliations

Enhancing Communication in Critically Ill Patients with a Tracheostomy: A Systematic Review of Evidence-Based Interventions and Outcomes

Mary N Gentile et al. Tracheostomy. 2024.

Abstract

Background: Tracheostomy, a common procedure performed in intensive care units (ICU), is associated with communication impairment and affects patient well-being. While prior research has focused on physiological care, there is a need to address communication needs and quality of life (QOL). We aimed to evaluate how different types of communication devices affect QOL, speech intelligibility, voice quality, time to significant events, clinical response and tolerance, and healthcare utilization in patients undergoing tracheostomy.

Methods: Following PRISMA guidelines, a systematic review was conducted to assess studies from 2016 onwards. Eligible studies included adult ICU patients with a tracheostomy, comparing different types of communication devices. Data were extracted and synthesized to evaluate QOL, speech intelligibility, voice quality, time to significant events (initial communication device use, oral intake, decannulation), clinical response and tolerance, and healthcare utilization and facilitators/barriers to device implementation.

Results: Among 9,228 studies screened, 8 were included in the review. Various communication devices were employed, comprising both tracheostomy types and speaking valves, highlighting the multifaceted nature of interventions. Quality of life improvements were observed with voice restoration interventions, but challenges such as speech intelligibility impairments were noted. The median time for initial communication device usage post-intervention was 11.4 ± 5.56 days. The median duration of speech tolerance ranged between 30-60 minutes to 2-3 hours across different studies. Complications such as air trapping or breathing difficulties were reported in 15% of cases. Additionally, the median ICU length of stay post-intervention was 36.5 days. Key facilitators for device implementation included early intervention, while barriers ranged from service variability to physical intolerance issues.

Conclusion: Findings demonstrate that various types of communication devices can significantly enhance the quality of life, speech intelligibility, and voice quality for patients undergoing tracheostomy, aligning with the desired outcomes of improved clinical response and reduced healthcare utilization. The identification of facilitators and barriers to device implementation further informs clinical practice, suggesting a tailored, patient-centered approach is crucial for optimizing the benefits of communication devices in this population.

Keywords: Communication; Critically ill patients; Evidence-based practice; Intensive care unit; Interprofessional team; Quality of life; Speech; Speech language pathologist; Systematic review; racheostomy.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest / Financial Disclosures Other authors report nothing to disclose.

Figures

Figure 1.
Figure 1.
Study Flow Chart
Figure 2.
Figure 2.
Risk of Bias Assessment
Figure 3.
Figure 3.
Level of Certainty using GRADE scoring
See this image and copyright information in PMC

References

    1. Whitmore KA, Townsend SC, Laupland KB. Management of tracheostomies in the intensive care unit: a scoping review. BMJ Open Resp Res. 2020;7(1):e000651. doi: 10.1136/bmjresp-2020-000651 - DOI - PMC - PubMed
    1. Brenner MJ, Pandian V, Milliren CE, et al. Global Tracheostomy Collaborative: data-driven improvements in patient safety through multidisciplinary teamwork, standardisation, education, and patient partnership. Br J Anaesth. 2020;125(1):e104–e118. doi: 10.1016/j.bja.2020.04.054 - DOI - PubMed
    1. Pandian V, Morris LL, Brodsky MB, et al. Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach. Am J Crit Care. 2020;29(6):e116–e127. doi: 10.4037/ajcc2020561 - DOI - PubMed
    1. Zaga CJ, Pandian V, Brodsky MB, et al. Speech-Language Pathology Guidance for Tracheostomy During the COVID-19 Pandemic: An International Multidisciplinary Perspective. Am J Speech Lang Pathol. 2020;29(3):1320–1334. doi: 10.1044/2020_ajslp-20-00089 - DOI - PubMed
    1. McGrath BA, Wallace S, Lynch J, et al. Improving tracheostomy care in the United Kingdom: results of a guided quality improvement programme in 20 diverse hospitals. Br J Anaesth. 2020;125(1):e119–e129. doi: 10.1016/j.bja.2020.04.064 - DOI - PubMed

LinkOut - more resources