Ability to speak in ventilator-dependent tracheostomized ICU patients

Abstract

Introduction Mechanical ventilation (MV) and inability to speak increases psycho-emotional distress [1]. Although not commonly used in ICU patients, MV with a deflated cuffin patients with a tracheostomy can be provided safely and comfortably, by use of a BiPAP Vision®. Air leakage to the upper airway enables speech [2]. By adding a Passy- Muir® speaking valve as second step, the quality of speech and cough will improve. The ability to speak provides an important improvement in communication. Methods The aim of this study was to compare weaning from MV by gradually decreasing the level of support in cuff-deflated ventilation with use of a BiPAP Vision® and a Passy Muir® speaking valve, or by trials of spontaneous breathing with use of a speaking valve, both for progressively longer periods of time. We examined the differences in the ability to speak, the duration of the weaning period, the occurrence of delirium and the frequency of tracheal suctioning. We performed a single-centre retrospective and prospective observational study in a 22-bed mixed ICU during 1 year. Data were collected using the patient data management system. Baseline criteria were age, gender, APACHE IV score, ICU length of stay and duration of MV before placement of the tracheostomy. Results Ten patients were included, five in the BiPAP group and five in the spontaneous group. There were no significant differences in the baseline criteria. On the second day after tracheostomy, three out of five patients in the BiPAP group were able to speak compared with one in the spontaneous method group. A difference in speaking ability remained until day 9 (see Figure 1). At first time of speaking, the BiPAP group had higher PEEP level (10 vs. 7.5 cmH2O) and higher SOFA score (6.2 vs. 4.6) compared with the spontaneous group. There was no significant difference in delirium, duration of weaning and tracheal suctioning between both groups. Conclusion Cuff-deflated MV in ICU patients enables speaking during ventilator dependence. With this technique the ability to speak started in an earlier phase of weaning compared with weaning with spontaneous breathing trials and a speaking valve. (Figure Presented).