A hands-free wearable electrolarynx for communication in tracheostomized mechanically ventilated critically ill patients: a case series

Abstract

The electrolarynx facilitates communication for tracheostomized mechanically ventilated patients. However, its effectiveness is often constrained by patient weakness. A hands-free electrolarynx offers a potential solution, enabling speech without the need to hold the device. This case series evaluated speech intelligibility with a hands-free electrolarynx in tracheostomized, mechanically ventilated patients. Seven tracheostomized patients were enrolled and instructed to use both the conventional and hands-free electrolarynxes. Speech intelligibility was assessed using the 5-point electrolarynx effectivity score (EES). Patients who scored ≥4 were defined as effective users. The median EES (interquartile range [IQR]) for the hands-free electrolarynx was 3.5 (2.5-4), with three effective users (42.9%). The median EES for the conventional electrolarynx when operated by the research staff was 4 (IQR: 3-4), with four effective users (57.1%), indicating no significant difference compared with the hands-free electrolarynx (p=0.7). However, none of the patients were able to effectively and independently utilize the conventional device, leading to a significantly lower median EES of 2 (IQR: 2-2.6; p = 0.03). The hands-free electrolarynx achieves greater intelligibility than the conventional electrolarynx when used independently by patients. The hands-free electrolarynx has the potential to minimize the need for external assistance and enhance autonomous communication.

Keywords: Communication tools; Electrolarynx; Intensive care; Mechanical ventilation; Tracheostomy.