1
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Ledl C, Frank U, Dziewas R, Arnold B, Bähre N, Betz CS, Braune S, Deitmer T, Diesener P, Fischer AS, Hamzic S, Iberl G, Konradi J, Löhler J, Platz T, Rohlfes C, Westhoff M, Winkler S, Wirth R, Graf S. [Curriculum "Tracheostomy management in dysphagia therapy"]. HNO 2024; 72:393-404. [PMID: 38578463 DOI: 10.1007/s00106-024-01454-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The number of tracheotomized patients with dysphagia and their need for treatment are continuously increasing in clinical and community settings. The revised version of the directive on home care and community-based intensive care of the Federal Joint Committee (G-BA) requires that tracheotomized patients are regularly evaluated with the aim of identifying and promoting the therapeutic potential after hospital discharge. Dysphagia treatment plays a crucial role as without improvement of severe dysphagia there is practically no possibility for decannulation. Tracheotomized patients with dysphagia are treated by speech and language therapists (SLT); however, the contents of tracheostomy management (TM) are not obligatory in the speech and language therapeutic training curricula, so that there is a need for further education and treatment standards must be secured. Therefore, the German Interdisciplinary Society for Dysphagia (DGD) in cooperation with the participating German medical and therapeutic societies developed a postgraduate curriculum for TM. This should serve as the basis for contents in TM and qualification of therapists within the framework of the delegation of medical services. The goals of the TM curriculum are the definition of theoretical and practical contents of TM, the qualification to perform TM according to current standards of care and quality assurance. The curriculum defines two qualification levels (user and trainer), entry requirements, curricular contents, examination and qualification criteria as well as transitional regulations for SLTs already experienced in TM.
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Affiliation(s)
- C Ledl
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland.
- Schön Klinik Bad Aibling, Bad Aibling, Deutschland.
| | - U Frank
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Swallowing Research Lab, Universität Potsdam, Potsdam, Deutschland
| | - R Dziewas
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Neurologie, Berlin, Deutschland
- Deutsche Gesellschaft für NeuroIntensiv- und Notfallmedizin, Jena, Deutschland
- Klinik für Neurologie und neurologische Frührehabilitation, Klinikum Osnabrück, Osnabrück, Deutschland
| | - B Arnold
- Deutscher Berufsverband für Phoniatrie und Pädaudiologie, Berlin, Deutschland
| | - N Bähre
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
| | - C S Betz
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Braune
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- St. Franziskus-Hospital Münster, Münster, Deutschland
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
| | - P Diesener
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
- Dysphagie-Netzwerk-Südwest e. V., Überlingen, Deutschland
- Dysphagie- und Kanülensprechstunde Hegau-Jugendwerk Gailingen, Gailingen, Deutschland
- Rehaklinik Zihlschlacht, Zihlschlacht-Sitterdorf, Schweiz
| | - A S Fischer
- Juristische Fakultät, Forschungsstelle Medizinrecht, Ludwig-Maximilians-Universität, München, Deutschland
| | - S Hamzic
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Universitätsklinikum Gießen und Marburg, Campus Gießen, Neurologische Klinik, Justus-Liebig-Universität, Gießen, Deutschland
| | - G Iberl
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
| | - J Konradi
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Institut für Physikalische Therapie, Prävention und Rehabilitation, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - J Löhler
- Deutscher Berufsverband der HNO-Ärzte, Neumünster, Deutschland
| | - T Platz
- Deutsche Gesellschaft für Neurorehabilitation, Berlin, Deutschland
- Institut für Neurorehabilitation und Evidenzbasierung, An-Institut der Universität Greifswald, BDH-Klinik Greifswald, Greifswald, Deutschland
- AG Neurorehabilitation, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - C Rohlfes
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- BDH-Klinik Hessisch Oldendorf, Hessisch Oldendorf, Deutschland
| | - M Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer, Deutschland
| | - S Winkler
- Deutscher Bundesverband für Logopädie, Frechen, Deutschland
| | - R Wirth
- Deutsche Gesellschaft für Geriatrie, Berlin, Deutschland
- Klinik für Altersmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland
| | - S Graf
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Phoniatrie und Pädaudiologie, Göttingen, Deutschland
- Universitätsklinik für Hör‑, Stimm- und Sprachstörungen, Medizinische Universität Innsbruck, Innsbruck, Österreich
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2
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Ledl C, Frank U, Dziewas R, Arnold B, Bähre N, Betz CS, Braune S, Deitmer T, Diesener P, Fischer AS, Hamzic S, Iberl G, Konradi J, Löhler J, Platz T, Rohlfes C, Westhoff M, Winkler S, Wirth R, Graf S. [Curriculum "Tracheostomy management in dysphagia therapy"]. DER NERVENARZT 2024; 95:342-352. [PMID: 38277047 PMCID: PMC11014872 DOI: 10.1007/s00115-023-01598-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Abstract
The number of tracheotomized patients with dysphagia and their need for treatment are continuously increasing in clinical and community settings. The revised version of the directive on home care and community-based intensive care of the Federal Joint Committee (G-BA) requires that tracheotomized patients are regularly evaluated with the aim of identifying and promoting the therapeutic potential after hospital discharge. Dysphagia treatment plays a crucial role as without improvement of severe dysphagia there is practically no possibility for decannulation. Tracheotomized patients with dysphagia are treated by speech and language therapists (SLT); however, the contents of tracheostomy management (TM) are not obligatory in the speech and language therapeutic training curricula, so that there is a need for further education and treatment standards must be secured. Therefore, the German Interdisciplinary Society for Dysphagia (DGD) in cooperation with the participating German medical and therapeutic societies developed a postgraduate curriculum for TM. This should serve as the basis for contents in TM and qualification of therapists within the framework of the delegation of medical services. The goals of the TM curriculum are the definition of theoretical and practical contents of TM, the qualification to perform TM according to current standards of care and quality assurance. The curriculum defines two qualification levels (user and trainer), entry requirements, curricular contents, examination and qualification criteria as well as transitional regulations for SLTs already experienced in TM.
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Affiliation(s)
- C Ledl
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland.
- Schön Klinik Bad Aibling, Bad Aibling, Deutschland.
| | - U Frank
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Swallowing Research Lab, Universität Potsdam, Potsdam, Deutschland
| | - R Dziewas
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Neurologie, Berlin, Deutschland
- Deutsche Gesellschaft für NeuroIntensiv- und Notfallmedizin, Jena, Deutschland
- Klinik für Neurologie und neurologische Frührehabilitation, Klinikum Osnabrück, Osnabrück, Deutschland
| | - B Arnold
- Deutscher Berufsverband für Phoniatrie und Pädaudiologie, Berlin, Deutschland
| | - N Bähre
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
| | - C S Betz
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Braune
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- St. Franziskus-Hospital Münster, Münster, Deutschland
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
| | - P Diesener
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
- Dysphagie-Netzwerk-Südwest e. V., Überlingen, Deutschland
- Dysphagie- und Kanülensprechstunde Hegau-Jugendwerk Gailingen, Gailingen, Deutschland
- Rehaklinik Zihlschlacht, Zihlschlacht-Sitterdorf, Schweiz
| | - A S Fischer
- Juristische Fakultät, Forschungsstelle Medizinrecht, Ludwig-Maximilians-Universität, München, Deutschland
| | - S Hamzic
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Universitätsklinikum Gießen und Marburg, Campus Gießen, Neurologische Klinik, Justus-Liebig-Universität, Gießen, Deutschland
| | - G Iberl
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
| | - J Konradi
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Institut für Physikalische Therapie, Prävention und Rehabilitation, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - J Löhler
- Deutscher Berufsverband der HNO-Ärzte, Neumünster, Deutschland
| | - T Platz
- Deutsche Gesellschaft für Neurorehabilitation, Berlin, Deutschland
- Institut für Neurorehabilitation und Evidenzbasierung, An-Institut der Universität Greifswald, BDH-Klinik Greifswald, Greifswald, Deutschland
- AG Neurorehabilitation, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - C Rohlfes
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- BDH-Klinik Hessisch Oldendorf, Hessisch Oldendorf, Deutschland
| | - M Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer, Deutschland
| | - S Winkler
- Deutscher Bundesverband für Logopädie, Frechen, Deutschland
| | - R Wirth
- Deutsche Gesellschaft für Geriatrie, Berlin, Deutschland
- Klinik für Altersmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland
| | - S Graf
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Phoniatrie und Pädaudiologie, Göttingen, Deutschland
- Universitätsklinik für Hör‑, Stimm- und Sprachstörungen, Medizinische Universität Innsbruck, Innsbruck, Österreich
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3
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Rose L, Messer B. Prolonged Mechanical Ventilation, Weaning, and the Role of Tracheostomy. Crit Care Clin 2024; 40:409-427. [PMID: 38432703 DOI: 10.1016/j.ccc.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Depending on the definitional criteria used, approximately 5% to 10% of critical adults will require prolonged mechanical ventilation with longer-term outcomes that are worse than those ventilated for a shorter duration. Outcomes are affected by patient characteristics before critical illness and its severity but also by organizational characteristics and care models. Definitive trials of interventions to inform care activities, such as ventilator weaning, upper airway management, rehabilitation, and nutrition specific to the prolonged mechanical ventilation patient population, are lacking. A structured and individualized approach developed by the multiprofessional team in discussion with the patient and their family is warranted.
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Affiliation(s)
- Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, 57 Waterloo Road, London SE1 8WA, UK; Department of Critical Care and Lane Fox Unit, Guy's & St Thomas' NHS Foundation Trust, King's College London, 57 Waterloo Road, London SE1 8WA, UK.
| | - Ben Messer
- Royal Victoria Infirmary, Newcastle-Upon-Tyne NHS Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
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4
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Dolinay T, Hsu L, Maller A, Walsh BC, Szűcs A, Jerng JS, Jun D. Ventilator Weaning in Prolonged Mechanical Ventilation-A Narrative Review. J Clin Med 2024; 13:1909. [PMID: 38610674 PMCID: PMC11012923 DOI: 10.3390/jcm13071909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/11/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Patients requiring mechanical ventilation (MV) beyond 21 days, usually referred to as prolonged MV, represent a unique group with significant medical needs and a generally poor prognosis. Research suggests that approximately 10% of all MV patients will need prolonged ventilatory care, and that number will continue to rise. Although we have extensive knowledge of MV in the acute care setting, less is known about care in the post-ICU setting. More than 50% of patients who were deemed unweanable in the ICU will be liberated from MV in the post-acute setting. Prolonged MV also presents a challenge in care for medically complex, elderly, socioeconomically disadvantaged and marginalized individuals, usually at the end of their life. Patients and their families often rely on ventilator weaning facilities and skilled nursing homes for the continuation of care, but home ventilation is becoming more common. The focus of this review is to discuss recent advances in the weaning strategies in prolonged MV, present their outcomes and provide insight into the complexity of care.
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Affiliation(s)
- Tamás Dolinay
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (L.H.); (A.M.); (B.C.W.); (D.J.)
- Barlow Respiratory Hospital, Los Angeles, CA 90026, USA
| | - Lillian Hsu
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (L.H.); (A.M.); (B.C.W.); (D.J.)
- Barlow Respiratory Hospital, Los Angeles, CA 90026, USA
| | - Abigail Maller
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (L.H.); (A.M.); (B.C.W.); (D.J.)
- Barlow Respiratory Hospital, Los Angeles, CA 90026, USA
| | - Brandon Corbett Walsh
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (L.H.); (A.M.); (B.C.W.); (D.J.)
- Barlow Respiratory Hospital, Los Angeles, CA 90026, USA
- Department of Medicine, Division of Palliative Care Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Attila Szűcs
- Department of Anesthesiology, András Jósa County Hospital, 4400 Nyíregyháza, Hungary;
| | - Jih-Shuin Jerng
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - Dale Jun
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA; (L.H.); (A.M.); (B.C.W.); (D.J.)
- Barlow Respiratory Hospital, Los Angeles, CA 90026, USA
- Pulmonary, Critical Care and Sleep Section, West Los Angeles VA Medical Center, Los Angeles, CA 90073, USA
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5
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Sutt AL, Fraser JF. Early versus late tracheostomy: what do patients want? Crit Care 2023; 27:151. [PMID: 37076935 PMCID: PMC10116655 DOI: 10.1186/s13054-023-04443-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Affiliation(s)
- Anna-Liisa Sutt
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia.
- Faculty of Medicine, University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia.
| | - John F Fraser
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia
- Faculty of Medicine, University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
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6
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Wallace S, McGowan S, Sutt AL. Benefits and options for voice restoration in mechanically ventilated intensive care unit patients with a tracheostomy. J Intensive Care Soc 2023; 24:104-111. [PMID: 36874291 PMCID: PMC9975806 DOI: 10.1177/17511437221113162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Communication difficulties and their effects on patients who are mechanically ventilated are commonly reported and well described. The possibility of restoring speech for patients has obvious benefits, not only for meeting patient's immediate needs, but for helping them to re-engage in relationships and participate meaningfully in their recovery and rehabilitation. This opinion piece by a group of United Kingdom (UK) based Speech and Language Therapy experts working in critical care describes the various ways by which a patient's own voice can be restored. Common barriers to using different techniques and potential solutions are explored. We therefore hope that this will encourage intensive care unit (ICU) multi-disciplinary teams to advocate and facilitate early verbal communication in these patients.
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Affiliation(s)
- Sarah Wallace
- Department of Speech Voice and Swallowing, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK.,Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, UK
| | - Sue McGowan
- Therapy Services, National Hospital for Neurology and Neurosurgery, UK
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia.,Speech and Language Therapy, The Royal London Hospital, UK
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7
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McRae J, Smith C, Beeke S, Emmanuel A. Development of a swallowing risk screening tool and best practice recommendations for the management of oropharyngeal dysphagia following acute cervical spinal cord injury: an international multi-professional Delphi consensus. Disabil Rehabil 2022; 44:8311-8324. [PMID: 34904488 DOI: 10.1080/09638288.2021.2012607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE International multi-professional expert consensus was sought to develop best practice recommendations for clinical management of patients following cervical spinal cord injury with oropharyngeal dysphagia and associated complications. Additionally, risk factors for dysphagia were identified to support the development of a screening tool. MATERIALS AND METHODS A two-round Delphi study was undertaken with a 27-member panel of expert professionals in cervical spinal cord injury and complex dysphagia. They rated 85 statements across seven topic areas in round one, using a five-point Likert scale with a consensus set at 70%. Statements not achieving consensus were revised for the second round. Comparative group and individual feedback were provided at the end of each round. RESULTS Consensus was achieved for 50 (59%) statements in round one and a further 12 (48%) statements in round two. Recommendations for best practice were agreed for management of swallowing, respiratory function, communication, nutrition and oral care. Twelve risk factors for dysphagia were identified for components of a screening tool. CONCLUSIONS Best practice recommendations support wider clinical management to prevent complications and direct specialist care. Screening for risk factors allows early dysphagia identification with the potential to improve clinical outcomes. Further evaluation of the impact of these recommendations is needed.Implications for RehabilitationDysphagia is an added complication following cervical spinal cord injury (cSCI) affecting morbidity, mortality and quality of life.Early identification of dysphagia risk allows focused interventions that reduce associated nutritional and respiratory impairments.Best practice recommendations based on expert consensus provide a baseline of appropriate interventions, in the absence of empirical evidence.A multi-professional approach to rehabilitation encourages a consistent and coordinated approach to care across acute and rehabilitation settings.
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Affiliation(s)
- Jackie McRae
- Centre for Allied Health, St George's University of London, London, UK
| | - Christina Smith
- Division of Psychology and Language Science, University College London, London, UK
| | - Suzanne Beeke
- Division of Psychology and Language Science, University College London, London, UK
| | - Anton Emmanuel
- Division of Medicine, University College London, London, UK
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8
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Lian S, Teng L, Mao Z, Jiang H. Clinical utility and future direction of speaking valve: A review. Front Surg 2022; 9:913147. [PMID: 36157432 PMCID: PMC9492950 DOI: 10.3389/fsurg.2022.913147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
This paper summarizes and analyzes the clinical research progress of the speaking valve in recent years, including the structure and function of the speaking valve, the impact of the speaking valve on the patient’s vocalization or speech, the impact on ventilator weaning and tracheal intubation and extubation, and the effect on aspiration and swallowing function, the impact on patient mobility and quality of life. Related issues in clinical use are also described.
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Affiliation(s)
- Suna Lian
- High-Dependency Care Unit, Beijing Rehabilitation Hospital, Beijing, China
| | - Liying Teng
- High-Dependency Care Unit, Beijing Rehabilitation Hospital, Beijing, China
| | - Zhi Mao
- Department of Critical Care Medicine, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Hongying Jiang
- High-Dependency Care Unit, Beijing Rehabilitation Hospital, Beijing, China
- Correspondence: Hongying Jiang
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9
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Sutt AL, Cornwell PL, Hay K, Fraser JF, Rose L. Communication Success and Speaking Valve Use in Intensive Care Patients Receiving Mechanical Ventilation. Am J Crit Care 2022; 31:411-415. [PMID: 36045040 DOI: 10.4037/ajcc2022516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Communication with patients receiving mechanical ventilation in an intensive care unit can be challenging. Once a patient is tracheostomized, a speaking valve may enable restoration of verbal communication. To date, no data are available on the effect of speaking valves on communication success in intensive care units. OBJECTIVE The aim of this prospective cohort study was to measure communication success before and during speaking valve use for intensive care patients being weaned from mechanical ventilation, from both the nurses' and the patients' perspectives. METHODS In a prospective cohort study, consecutive eligible patients and their nurses were asked to complete newly developed questionnaires on communication success before and while patients used a speaking valve (6 questions for patients, 5 questions for nurses, answers on a 10-point scale with 10 the best score). The Wilcoxon signed rank test was used to analyze score differences. RESULTS For all questionnaire items, both patients (n = 25) and nursing staff (n = 52) reported significantly higher communication success during speaking valve use. Nurses understood moderately well that their patients were in pain (median [IQR], 5.8 [4.7-7.4]) even before speaking valve use. Most patients found it challenging to say something quickly even while using a speaking valve (6.9 [5.7-10.0]). Overall, speaking valve use markedly increased communication success. CONCLUSION A speaking valve should be considered for patients with a tracheostomy as soon as possible to improve their communication success.
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Affiliation(s)
- Anna-Liisa Sutt
- Anna-Liisa Sutt is a speech pathologist, Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia and an industry fellow, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Petrea L Cornwell
- Petrea L. Cornwell is an associate professor, School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Karen Hay
- Karen Hay is a statistician, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - John F Fraser
- John F. Fraser is director, Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia and a professor, Faculty of Medicine, University of Queensland
| | - Louise Rose
- Louise Rose is a professor, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
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10
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Tronstad O, Martí JD, Ntoumenopoulos G, Gosselink R. An Update on Cardiorespiratory Physiotherapy during Mechanical Ventilation. Semin Respir Crit Care Med 2022; 43:390-404. [PMID: 35453171 DOI: 10.1055/s-0042-1744307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Physiotherapists are integral members of the multidisciplinary team managing critically ill adult patients. However, the scope and role of physiotherapists vary widely internationally, with physiotherapists in some countries moving away from providing early and proactive respiratory care in the intensive care unit (ICU) and focusing more on early mobilization and rehabilitation. This article provides an update of cardiorespiratory physiotherapy for patients receiving mechanical ventilation in ICU. Common and some more novel assessment tools and treatment options are described, along with the mechanisms of action of the treatment options and the evidence and physiology underpinning them. The aim is not only to summarize the current state of cardiorespiratory physiotherapy but also to provide information that will also hopefully help support clinicians to deliver personalized and optimal patient care, based on the patient's unique needs and guided by accurate interpretation of assessment findings and the current evidence. Cardiorespiratory physiotherapy plays an essential role in optimizing secretion clearance, gas exchange, lung recruitment, and aiding with weaning from mechanical ventilation in ICU. The physiotherapists' skill set and scope is likely to be further optimized and utilized in the future as the evidence base continues to grow and they get more and more integrated into the ICU multidisciplinary team, leading to improved short- and long-term patient outcomes.
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Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia.,Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia
| | - Joan-Daniel Martí
- Cardiac Surgery Critical Care Unit, Institut Clinic Cardiovascular, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Rik Gosselink
- Department Rehabilitation Sciences, University of Leuven, University Hospitals Leuven, Belgium
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11
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Li J, Perez A, Schehl J, Albers A, Husain IA. The Association Between Upper Airway Patency and Speaking Valve Trial Tolerance for Patients With Tracheostomy: A Clinical Retrospective Study and an In Vitro Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1728-1736. [PMID: 34057847 DOI: 10.1044/2021_ajslp-20-00331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Purpose Upper airway patency is crucial in a patient's ability to tolerate a one-way speaking valve (SV). Traditional assessment of airway patency is mainly subjective. We developed four noninvasive methods to assess patency (leak volume, transtracheal pressure [TTP], end-tidal CO2, and Mallampati score) in our institution. This study was aimed to evaluate the effectiveness of the four methods and explore the relationship between the patient's upper airway patency and SV trial tolerance. Method A retrospective cohort study was conducted to enroll adult patients with tracheostomies eligible for an SV trial from April 2019 through January 2020. An in vitro study was also implemented to explore the relationship between upper airway patency and noninvasive measurements. Results Forty patients (22 men and 18 women) were included; 16 used SV in-line with mechanical ventilation. Twenty-four patients tolerated an SV trial of > 10 min; they had lower TTP (3.0 [2.0-9.0] vs. 15.0 [9.3-21.3] cm H2O, p < .001), higher leak volume (268.5 ± 177.2 vs. 88.6 ± 99.6 ml, p = .038), and lower percentage of patients with Mallampati Classification IV (16.7 vs. 50.0%, p = .035), compared to the 16 patients who did not tolerate an SV trial. Twenty-two patients with a TTP of ≤ 9 cm H2O had higher percentage tolerating an SV trial than those with a TTP of > 9 cm H2O (86.4 vs. 35.3%, p = .002). The in vitro study demonstrated a strong correlation between upper airway patency and TTP, peak inspiratory flow, and tidal volume inhaled from the upper airway. Conclusions TTP, Mallampati classification, and leak volume can be used to assess upper airway patency for adult patients with tracheostomies undergoing an SV trial. A TTP of ≤ 9 cm H2O might indicate adequate upper airway patency to tolerate the SV trial.
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Affiliation(s)
- Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL
| | - Andrew Perez
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL
| | - Joan Schehl
- Department of Speech-Language Pathology, Rush University Medical Center, Chicago, IL
| | - Allison Albers
- Department of Speech-Language Pathology, Rush University Medical Center, Chicago, IL
| | - Inna A Husain
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL
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Lima JADCD, Collet N, Baggio MA, Almeida AMD. Aleitamento materno na experiência de mães de crianças traqueostomizadas e o uso da válvula Passy-Muir®. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo compreender a experiência de mães de crianças traqueostomizadas, entre 0 e 24 meses de idade, que retomaram o aleitamento materno com o uso de válvula de deglutição Passy-Muir®. Método pesquisa descritiva, de natureza qualitativa, com 11 mães de crianças traqueostomizadas que adaptaram a válvula de deglutição Passy-Muir®, acompanhadas em um centro de reabilitação e fonoaudiologia, mediante entrevistas semiestruturadas, nos meses de junho a agosto de 2017. A análise foi fundamentada nos pressupostos da análise de conteúdo temática. Resultados na experiência das mães, após a traqueostomia da criança, o uso da válvula de deglutição Passy-Muir® minimizou as dificuldades no aleitamento materno. Superado o processo de adaptação da válvula, foram percebidos seus benefícios. São descritos os sentimentos das mães nesse processo, suas expectativas quanto ao uso do dispositivo e o prazer e plenitude para a mulher no retorno do aleitamento materno. Conclusões e implicações para a prática observaram-se segurança ao aleitar, menor produção de secreção, reduções no número de aspirações de vias áreas, melhora no padrão respiratório, vocalizações (balbucios e choro), melhora na qualidade do sono da criança. Novas pesquisas que abordem o aleitamento materno de crianças traqueostomizadas são necessárias para aprofundar conhecimentos nesta área.
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13
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Wiberg S, Whitling S, Bergström L. Tracheostomy management by speech-language pathologists in Sweden. LOGOP PHONIATR VOCO 2020; 47:146-156. [PMID: 33356717 DOI: 10.1080/14015439.2020.1847320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose: Speech-language pathologists' (SLPs) role in tracheostomy management is well described internationally. Surveys from Australia and the United Kingdom show high clinical consistency in SLP tracheostomy management, and that practice follows guidelines, research evidence and protocols. Swedish SLPs work with tracheostomised patients, however, the content and extent of this practice, and how it compares to international research is unknown. This study reports how SLPs in Sweden work with tracheostomised patients, investigating (a) the differences and similarities in SLPs tracheostomy management and (b) the facilitators and barriers to tracheostomy management, as reported by SLPs.Methods: A study-specific, online questionnaire was completed by 28 SLPs who had managed tracheostomised patients during the previous year. This study was conducted in 2018, pre Covid-19 pandemic. The answers were analysed for exploratory descriptive comparison of data. Content analyses were made on answers from open-ended questions.Results: Swedish SLPs manage tracheostomised patients, both for dysphagia and communication. During this study, the use of protocols and guidelines were limited and SLPs were often not part of a tracheostomy team. Speech-language pathologists reported that the biggest challenges in tracheostomy management were in (a) collaboration with other professionals, (b) unclear roles and (c) self-perceived inexperience. Improved collaboration with other professionals and clearer roles was suggested to facilitate team tracheostomy management.Conclusions: This study provides insight into SLP tracheostomy management in Sweden, previously uncharted. Results suggest improved collaboration, further education and clinical training as beneficial for a clearer and more involved SLP role in tracheostomy management.
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Affiliation(s)
- Sara Wiberg
- Department of Speech and Language Therapy, Helsingborg Hospital, Helsingborg, Sweden.,Department of Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Susanna Whitling
- Department of Logopedics, Phoniatrics and Audiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Liza Bergström
- Division of Speech and Language Pathology, Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,REMEO Stockholm, Sköndal, Sweden
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14
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Thomas AJ, Talbot E, Drewery H. Failure of standard tracheostomy decannulation criteria to detect suprastomal pathology. Anaesth Rep 2020; 8:67-70. [PMID: 33163965 DOI: 10.1002/anr3.12048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 11/08/2022] Open
Abstract
Meeting established criteria for tracheostomy decannulation should improve success, although there will be a small proportion of patients with a tracheostomy who fail decannulation. Failure rates depend on patient characteristics and disparity between institutional practices and expert opinion. However, there are no widely accepted published failure rates, or agreement on the time-point at which failure is assessed. We present a patient who had evidence of readiness for decannulation, but had immediate failure due to extrinsic tracheal compression, which proved difficult to diagnose and required surgery to resolve. Capping the tracheostomy before decannulation may or may not have given rise to suspicion of potential failure and this practice requires further evaluation as it is not without risk. For subglottic, but suprastomal lesions, nasendoscopy is not of value. It is important to decannulate patients in a safe environment, preferably early in the day to allow post decannulation observations and interventions should they become necessary, and with the close involvement of the multi-professional team. This report illustrates the failure of our standard Tracheostomy decannulation criteria, and direct upper airway view to identify suprastomal tracheal pathology, and we discuss the potential for additional criteria which may have identified the issue before decannulation attempts.
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Affiliation(s)
- A J Thomas
- Critical Care Outreach Team The Royal London Hospital London UK
| | - E Talbot
- Speech and Language Therapy The Royal London Hospital London UK
| | - H Drewery
- Department of Anaesthetics The Royal London Hospital London UK
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15
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Sutt AL, Hay K, Kinneally T, Fisquet S, Fraser JF. Sedatives, analgesics and antipsychotics in tracheostomised ICU patients - Is less more? Aust Crit Care 2019; 33:407-411. [PMID: 31495639 DOI: 10.1016/j.aucc.2018.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/22/2018] [Accepted: 12/11/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Sedation and anaesthesia are used universally to facilitate mechanical ventilation - with larger cumulative doses being used in those with prolonged ventilation. Transitioning from an endotracheal to a tracheostomy tube enables the depth of sedation to be reduced. Early use of speaking valves with tracheostomised patients has become routine in some intensive care units (ICU). The return of verbal communication has been observed to improve ease of patient care and increase patient and family engagement, with a perceived reduction in patient agitation. OBJECTIVES To investigate the potential impact of speaking valve (SV) use on requirements of sedatives, analgesics and antipsychotics in ICU patients with a tracheostomy. METHODS A retrospective data audit was undertaken for all tracheostomised patients in a cardio-respiratory ICU from 2011 to 2014. Use of sedative, analgesic and antipsychotic drugs was captured for endotracheal tube, tracheostomy and SV periods, including patient demographics, disease specifics and severity. Stratified Cox regression analysis was performed to determine the effects of SV on drug dosage. RESULTS Of 257 patients, 144 (56%) received an SV. Use of an SV was associated with reduced risk of being in the upper quartile of daily dosage of analgesics (HR: 0.6; 95% CI: 0.5-0.8; p < 0.001). In the final adjusted multivariable model, analgesic dose was additionally associated with age, and attendance to operating theatre during ICU. Sedative dose was associated with age, gender and SOFA score. Antipsychotic dose was associated with gender (less likely in females: HR 0.6, 95% CI: 0.4-0.8), age and APACHE score. CONCLUSIONS There was significantly less analgesic used in patients with an SV compared to those without. However, SV use in patients with tracheostomy was not found to be associated with reduced dose of sedatives or antipsychotics, despite the clinical impression. Future prospective studies are needed to more adequately investigate the association between drugs and patients' ability to verbally participate in their care.
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Affiliation(s)
- Anna-Liisa Sutt
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medical and Biomedical Sciences, The University of Queensland, Brisbane, Australia; Barts Health NHS Trust, London, United Kingdom.
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston QLD 4006, Brisbane, Australia.
| | - Toni Kinneally
- Faculty of Medical and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Stephanie Fisquet
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia; Pharmacy Department, The Prince Charles Hospital, Brisbane, Australia.
| | - John F Fraser
- Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medical and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
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Abstract
PURPOSE OF REVIEW Modern medical advances have resulted in an increased survival after extremely preterm birth. However, some infants will develop severe bronchopulmonary dysplasia (BPD) and fail to wean from invasive or noninvasive positive pressure support. It remains unclear which infants will benefit from tracheostomy placement for chronic ventilation. Once the decision to pursue chronic ventilation has been made, questions remain with respect to the timing of tracheotomy surgery, optimal strategies for mechanical ventilation, and multidisciplinary care in both the inpatient and outpatient settings. The appropriate time for weaning mechanical ventilation and tracheostomy decannulation has similarly not been determined. RECENT FINDINGS Although there remains a paucity of randomized controlled trials involving infants with severe BPD, a growing body of evidence suggests that chronic ventilation via tracheostomy is beneficial to support the growth and development of severely affected preterm children. However, delivering such care is not without risk. Chronic ventilation via tracheostomy requires complex care coordination and significant resource utilization. SUMMARY When chronic respiratory insufficiency limits a preterm infant's ability to grow and develop, chronic invasive ventilation may facilitate neurodevelopmental progress and may lead to an improved long-term outcome.
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17
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Fisser C, Spoletini G, Soe AK, Livesey A, Schreiber A, Swingwood E, Bos LD, Dreher M, Schultz MJ, Heunks L, Scala R. European Respiratory Society International Congress 2018: highlights from Assembly 2 on respiratory intensive care. ERJ Open Res 2019; 5:00198-2018. [PMID: 30847349 PMCID: PMC6397914 DOI: 10.1183/23120541.00198-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/28/2019] [Indexed: 12/14/2022] Open
Abstract
The respiratory intensive care Assembly of the European Respiratory Society is proud to present a summary of several important sessions held at the International Congress in Paris in 2018. For the highly esteemed reader who may have missed the Congress, a concise review was written on three topics: the state-of-the-art session on respiratory critical care, hot topics in weaning and the best abstracts in noninvasive ventilation. The respiratory intensive care Assembly of the European Respiratory Society is proud to present a summary of several important sessions from the 2018 #ERSCongress in Parishttp://ow.ly/6Du830nFESK
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Affiliation(s)
- Christoph Fisser
- Dept of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.,Dept of Pneumology, Hospital Donaustauf, Donaustauf, Germany
| | - Giulia Spoletini
- Respiratory Dept, St James's University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK.,Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Aung Kyaw Soe
- Dept of Hospital Therapy, Pediatric Faculty, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Alana Livesey
- Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Annia Schreiber
- Dept of Medicine, Division of Respirology, University Health Network, Toronto, ON, Canada
| | - Ema Swingwood
- Physiotherapy Dept - Adult Therapy Services, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lieuwe D Bos
- Dept of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Michael Dreher
- Dept of Pneumology and Intensive Care Medicine, University Hospital Aachen, Germany
| | - Marcus J Schultz
- Dept of Intensive Care, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Leo Heunks
- Dept of Intensive Care, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
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18
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Ambrosino N, Vitacca M. The patient needing prolonged mechanical ventilation: a narrative review. Multidiscip Respir Med 2018; 13:6. [PMID: 29507719 PMCID: PMC5831532 DOI: 10.1186/s40248-018-0118-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/07/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Progress in management has improved hospital mortality of patients admitted to the intensive care units, but also the prevalence of those patients needing weaning from prolonged mechanical ventilation, and of ventilator assisted individuals. The result is a number of difficult clinical and organizational problems for patients, caregivers and health services, as well as high human and financial resources consumption, despite poor long-term outcomes. An effort should be made to improve the management of these patients. This narrative review summarizes the main concepts in this field. MAIN BODY There is great variability in terminology and definitions of prolonged mechanical ventilation.There have been several recent developments in the field of prolonged weaning: ventilatory strategies, use of protocols, early mobilisation and physiotherapy, specialised weaning units.There are few published data on discharge home rates, need of home mechanical ventilation, or long-term survival of these patients.Whether artificial nutritional support improves the outcome for these chronic critically ill patients, is unclear and controversial how these data are reported on the optimal time of initiation of parenteral vs enteral nutrition.There is no consensus on time of tracheostomy or decannulation. Despite several individualized, non-comparative and non-validated decannulation protocols exist, universally accepted protocols are lacking as well as randomised controlled trials on this critical issue. End of life decisions should result from appropriate communication among professionals, patients and surrogates and national legislations should give clear indications. CONCLUSION Present medical training of clinicians and locations like traditional intensive care units do not appear enough to face the dramatic problems posed by these patients. The solutions cannot be reserved to professionals but must involve also families and all other stakeholders. Large multicentric, multinational studies on several aspects of management are needed.
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Affiliation(s)
- Nicolino Ambrosino
- Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Montescano, 27040 Montescano, PV Italy
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri, IRCCS, Respiratory Unit, Istituto Scientifico di Lumezzane, Lumezzane, BS Italy
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19
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Ventilation distribution and lung recruitment with speaking valve use in tracheostomised patient weaning from mechanical ventilation in intensive care. J Crit Care 2017; 40:164-170. [PMID: 28411422 DOI: 10.1016/j.jcrc.2017.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/21/2017] [Accepted: 04/05/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Speaking valves (SV) are used infrequently in tracheostomised ICU patients due to concerns regarding their putative effect on lung recruitment. A recent study in cardio-thoracic population demonstrated increased end-expiratory lung volumes during and post SV use without examining if the increase in end-expiratory lung impedance (EELI) resulted in alveolar recruitment or potential hyperinflation in discrete loci. MATERIALS AND METHODS A secondary analysis of Electrical Impedance Tomography (EIT) data from a previous study was conducted. EELI distribution and tidal variation (TV) were assessed with a previously validated tool. A new tool was used to investigate ventilated surface area (VSA) and regional ventilation delay (RVD) as indicators of alveolar recruitment. RESULTS The increase in EELI was found to be uniform with significant increase across all lung sections (p<0.001). TV showed an initial non-significant decrease (p=0.94) with subsequent increase significantly above baseline (p<0.001). VSA and RVD showed non-significant changes during and post SV use. CONCLUSIONS These findings indicate that hyperinflation did not occur with SV use, which is supported by previously published data on respiratory parameters. These data along with obvious psychological benefits to patients are encouraging towards safe use of SVs in this critically ill cardio-thoracic patient population. TRIAL REGISTRATION Anna-Liisa Sutt, Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN ACTRN12615000589583. 4/6/2015.
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20
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Tuinman PR, Ten Hoorn S. Freedom of speech for all critically ill patients: work in progress. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:27. [PMID: 28173826 PMCID: PMC5296959 DOI: 10.1186/s13054-017-1608-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- P R Tuinman
- Department of Intensive Care Medicine and Research VUmc Intensive Care (REVIVE), VU University Medical Center Amsterdam, Room ZH-7D-166, De Boelelaan 1117, PO Box 7057, MB, Amsterdam, 1007, The Netherlands. .,Institute for Cardiovascular Research VU (ICaR-VU), VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
| | - S Ten Hoorn
- Department of Intensive Care Medicine and Research VUmc Intensive Care (REVIVE), VU University Medical Center Amsterdam, Room ZH-7D-166, De Boelelaan 1117, PO Box 7057, MB, Amsterdam, 1007, The Netherlands.,Institute for Cardiovascular Research VU (ICaR-VU), VU University Medical Center Amsterdam, Amsterdam, The Netherlands
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21
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Egbers PH, Boerma EC. Communicating with conscious mechanically ventilated critically ill patients: let them speak with deflated cuff and an in-line speaking valve! CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:7. [PMID: 28069050 PMCID: PMC5223307 DOI: 10.1186/s13054-016-1587-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Peter H Egbers
- Department of Intensive Care, Medical Centre Leeuwarden, P.O. Box 888, 8901 BK, Leeuwarden, Netherlands.
| | - E Christiaan Boerma
- Department of Intensive Care, Medical Centre Leeuwarden, P.O. Box 888, 8901 BK, Leeuwarden, Netherlands
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22
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Sutt AL, Fraser JF. Patients want to be heard-loud and clear! CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:6. [PMID: 28069022 PMCID: PMC5223441 DOI: 10.1186/s13054-016-1588-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Anna-Liisa Sutt
- Speech Pathology Department, The Prince Charles Hospital, Brisbane, Australia. .,Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia. .,School of Medicine, University of Queensland, Brisbane, Australia.
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
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23
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One-Way, Positive-Pressure Speaking Valve During Mechanical Ventilation Via Tracheostomy Tube: Risks or Benefits? Crit Care Med 2016; 44:e1146-e1147. [PMID: 27755087 DOI: 10.1097/ccm.0000000000001991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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