Tracheostomy Tube Enabling Speech During Mechanical Ventilation

doi:10.1378/chest.125.3.1046

Chest

Volume 125, Issue 3, March 2004, Pages 1046-1051

https://doi.org/10.1378/chest.125.3.1046 Get rights and content

Background

A voice tracheostomy tube (VTT) was developed to enable patients to speak during mechanical ventilation.

Methods

The VTT has slits cut in it and is covered on part of its side with an elastic cuff, enabling the cuff to expand with positive pressure from the ventilator on inspiration and to deflate on expiration. By this mechanism, inspired air from the ventilator goes to the lung with the cuff inflated, and some of the expired air passes out around the deflated cuff and discharges through the glottis, allowing sufficient ventilation and also enabling vocal fold vibration. An experiment using a model lung showed that there was little leakage on inspiration even for low lung compliance and high airway pressure, and that the leakage volume on expiration was approximately 40% of the ventilated volume, ie, the volume discharging through the vocal fold in clinical use.

Results

Sixteen patients who had been managed by ventilation via a conventional tracheostomy tube were switched to the VTT. All patients except one were able to speak after switching to the VTT without change in Pao₂ and Paco₂. There were no complications associated with the use of the VTT. Bronchoscopy showed that the cuff of the VTT did not damage the tracheal mucosa.

Conclusion

The VTT enables patients to speak during mechanical ventilation with sufficient ventilation and without aspiration and damage to the tracheal mucosa, even in patients with low lung compliance.

Section snippets

Materials and Methods

The structure of the VTT is shown in Figure 1. The tube part of the VTT is made of polyvinyl chloride. The VTT has two slits 10 mm in length and 2 mm in width down its side, and this part of the tube is covered with an elastic cuff made from polyurethane approximately 0.1 mm in thickness. Both edges of the cuff are bonded on the tube. This structure connects the insides of the cuff and tube with each other. The cuff therefore expands with positive pressure from the ventilator on inspiration and

Results

In both volume- and pressure-controlled modes for the model lung, the VTT showed some air leakage on inspiration, but the leakage was usually < 10% of the inspired volume from the ventilator, even under conditions of low lung compliance and high airway pressure (Tables 2,3). There was no significant difference of ventilated volume, expired volume, airway pressure, and leakage volume between 0 cm H₂O and 5 cm H₂O of PEEP. On expiration, the air leakage volume via the gap between the VTT and

Discussion

Our study using a model lung showed that the VTT could be used in both pressure-controlled and volume-controlled ventilation. The leakage volume on inspiration was < 10% of the inspired volume from the ventilator, even under conditions of low lung compliance. The leakage volume on expiration was approximately 40% of the ventilated volume; this volume refers to the air expired via the vocal fold in clinical use, which could be enough for speech. The VTT could be useful for low lung compliance,

References (7)

JR Bach et al.
Tracheostomy ventilation: a study of efficacy with deflated cuffs and cuffless tubes
Chest
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H Nomori et al.
Assisted pressure control ventilation via a mini-tracheostomy tube for postoperative respiratory management of lung cancer patients
Respir Med
(2000)
H Nomori et al.
Pressure-controlled ventilation via a mini-tracheostomy tube for patients with neuromuscular disease
Neurology
(2000)

There are more references available in the full text version of this article.

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2016, Surgery (United States)
Eye-tracking devices have been suggested as a means of improving communication and psychosocial status among patients in the intensive care unit (ICU). This study was undertaken to explore the psychosocial impact and communication effects of eye-tracking devices in the ICU.
A convenience sample of patients in the medical ICU, surgical ICU, and neurosciences critical care unit were enrolled prospectively. Patients participated in 5 guided sessions of 45 minutes each with the eye-tracking computer. After completion of the sessions, the Psychosocial Impact of Assistive Devices Scale (PIADS) was used to evaluate the device from the patient's perspective.
All patients who participated in the study were able to communicate basic needs to nursing staff and family. Delirium as assessed by the Confusion Assessment Method for the Intensive Care Unit was present in 4 patients at recruitment and none after training. The device's overall psychosocial impact ranged from neutral (−0.29) to strongly positive (2.76). Compared with the absence of intervention (0 = no change), patients exposed to eye-tracking computers demonstrated a positive mean overall impact score (PIADS = 1.30; P = .004). This finding was present in mean scores for each PIADS domain: competence = 1.26, adaptability = 1.60, and self-esteem = 1.02 (all P < .01).
There is a population of patients in the ICU whose psychosocial status, delirium, and communication ability may be enhanced by eye-tracking devices. These 3 outcomes are intertwined with ICU patient outcomes and indirectly suggest that eye-tracking devices might improve outcomes. A more in-depth exploration of the population to be targeted, the device's limitations, and the benefits of eye-tracking devices in the ICU is warranted.
Outcome and attitudes toward home tracheostomy ventilation of consecutive patients: A 10-year experience
2008, Respiratory Medicine
Citation Excerpt :
In our study, the survival rate was the same in both groups, cuffed and cuffless. This indicates that to use cuffless tracheostomy tubes can help reduce tracheal complications and swallowing dysfunctions,22 improving patients’ speech.23–25 Another important aspect that we investigated in this study regards the factors potentially related to survival after invasive ventilation.
To describe survival, predictors of long-term outcome and attitudes in patients treated at home by tracheostomy-intermittent positive-pressure ventilation (TIPPV) for respiratory failure during a 10-year period (1995–2004).
Seventy-seven consecutive patients were treated by TIPPV at home. Patients were divided into three groups: neuromuscular, pulmonary, and non-pulmonary patients. Effects of TIPPV on survival, factors influencing outcome after TIPPV, and attitudes of patients and caregivers regarding mechanical ventilation were studied.
Forty-one patients (53%) were neuromuscular, 19 (25%) were affected by pulmonary diseases, and 17 (22%) by non-pulmonary diseases. The median survival time after TIPPV in the group was 49 months (range 3–149 months). There was statistically significant longer survival in neuromuscular compared to pulmonary patients (p=0.006), and a trend toward longer survival for non-pulmonary when compared to pulmonary patients (p=0.048). Chronic obstructive pulmonary disease (COPD) patients (n=14) showed the poorest outlook (median survival 26 months, range 3–45 months) and the highest number of emergency readmissions to hospital. The median survival in amyotrophic lateral sclerosis (ALS) patients was 49 months (range 30–61), lower than the whole group of neuromuscular patients. Major tracheostomy complications were low: 2.6%. Multivariate analysis showed that COPD and ALS patients had a three-fold higher risk of death than patients with other diagnoses. Lastly, 64 patients (83%) were pleased they had chosen TIPPV and 69 (90%) would choose it again. Forty-two caregivers (55%) were pleased the patients had chosen home ventilation, but 29 (38%) reported major burdens.
TIPPV is well-received by the patients, is safe, and provides survival for long periods of time. Underlying conditions (COPD and ALS) might represent important prognostic factors for survival.
Optimising speech during artificial ventilation
2005, Revue des Maladies Respiratoires
La parole est une composante essentielle de la qualité de vie des patients ventilés au long cours. Tenter de rétablir une phonation doit toujours être une des préoccupations des praticiens en charge de ces patients.
Nous passons en revue les différents outils et techniques disponibles afin de rétablir une phonation chez les patients ventilés au long cours que ce soit de façon continue ou discontinue.
Speech is an essential component of quality of life for patients treated with long term mechanical ventilation. Therefore trying to improve phonation should always sought by physicians treating these patients.
We review the different tools and techniques available in order to restore speech for patients with home mechanical ventilation whether ventilation is done continuously or not.
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2023, Journal of the Intensive Care Society
Comparison of SIMV + PS and AC modes in chronically ventilated children and effects on speech
2021, Pediatric Pulmonology
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2020, BMJ Open Respiratory Research

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Chest

Clinical Investigations in Critical CareTracheostomy Tube Enabling Speech During Mechanical Ventilation

Background

Methods

Results

Conclusion

Section snippets

Materials and Methods

Results

Discussion

Chest

Respir Med

Pressure-controlled ventilation via a mini-tracheostomy tube for patients with neuromuscular disease

Neurology

Clinical Investigations in Critical Care
Tracheostomy Tube Enabling Speech During Mechanical Ventilation