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Enabling speech in ICU patients during mechanical ventilation.

Egbers PH, Bultsma R, Middelkamp H, Boerma EC - Intensive Care Med (2014)

View Article: PubMed Central - PubMed

Affiliation: Medical Center Leeuwarden, Leeuwarden, Netherlands.

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One way to enable speech in tracheotomised patients during the weaning period is to alternate MV with time-limited trials of cuff-deflated spontaneous breathing in combination a speaking valve... Although not commonly used, MV with deflated cuff in tracheotomised patients may be an alternative approach, and has been provided safely and comfortably in selected groups of non-ICU patients... Its use has been associated with improved swallowing and the possibility to speak... We describe our experiences to improve speech in tracheotomised ICU patients during cuff-deflated MV, in combination with a high flow non-invasive ventilator and a one-way tracheostomy speaking valve... Five patients were weaned from MV without the ability to speak, one patient died within 2 days after the tracheotomy, and one patient had persistent insufficient air leakage around the cannula, despite reduction in cannula size... A minimum PEEP level of 8 cmH2O was maintained in order to prevent rebreathing of CO2... Furthermore, an increasing level of PEEP has been associated with a prolonged duration and improved quality of speech... In case all expiratory flow passed through the oropharyngeal route, a Passy Muir speaking valve (Passy Muir Inc., Irvine, USA) was installed in the circuit to enhance speech (Fig.  1)... All 12 patients were able to speak in the first day after switching to the BiPAP setting, enabling effective communication with relatives and medical personnel... Quality and duration of speech improved over time... Median time from the beginning of speech to the end of MV was 12 ± 6 days... We conclude that in a selected group of difficult-to-wean tracheotomised ICU patients the ability to speak may effectively be restored by cuff-deflated non-invasive BiPAP ventilation in combination with a one-way speaking valve.

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Ventilator setting; Passy Muir® one-way speaking valve in red circle
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Fig1: Ventilator setting; Passy Muir® one-way speaking valve in red circle

Mentions: In 2013, 24 patients in our mixed medical-surgical ICU were tracheotomised, using a percutaneous dilatation technique. Five patients were able to wean and speak with progressive periods of spontaneous breathing trials. Five patients were weaned from MV without the ability to speak, one patient died within 2 days after the tracheotomy, and one patient had persistent insufficient air leakage around the cannula, despite reduction in cannula size. Table 1 summarizes the characteristics of the remaining 12 patients. Within 24 h after the tracheotomy procedure air leakage was present after deflation of the cuff. Invasive pressure support ventilation was replaced by a BiPAP mode with a non-invasive ventilator (BiPAP Vision®, Philips, Best, the Netherlands) at equal ventilator settings. A minimum PEEP level of 8 cmH2O was maintained in order to prevent rebreathing of CO2. Furthermore, an increasing level of PEEP has been associated with a prolonged duration and improved quality of speech [5]. In case all expiratory flow passed through the oropharyngeal route, a Passy Muir® speaking valve (Passy Muir Inc., Irvine, USA) was installed in the circuit to enhance speech (Fig. 1). All 12 patients were able to speak in the first day after switching to the BiPAP setting, enabling effective communication with relatives and medical personnel. Quality and duration of speech improved over time. Effective weaning from MV was achieved in all patients by progressive intervals of CPAP. During CPAP the ability to speak was similar to that in the BiPAP mode. Median time from the beginning of speech to the end of MV was 12 ± 6 days.Table 1


Enabling speech in ICU patients during mechanical ventilation.

Egbers PH, Bultsma R, Middelkamp H, Boerma EC - Intensive Care Med (2014)

Ventilator setting; Passy Muir® one-way speaking valve in red circle
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4061473&req=5

Fig1: Ventilator setting; Passy Muir® one-way speaking valve in red circle
Mentions: In 2013, 24 patients in our mixed medical-surgical ICU were tracheotomised, using a percutaneous dilatation technique. Five patients were able to wean and speak with progressive periods of spontaneous breathing trials. Five patients were weaned from MV without the ability to speak, one patient died within 2 days after the tracheotomy, and one patient had persistent insufficient air leakage around the cannula, despite reduction in cannula size. Table 1 summarizes the characteristics of the remaining 12 patients. Within 24 h after the tracheotomy procedure air leakage was present after deflation of the cuff. Invasive pressure support ventilation was replaced by a BiPAP mode with a non-invasive ventilator (BiPAP Vision®, Philips, Best, the Netherlands) at equal ventilator settings. A minimum PEEP level of 8 cmH2O was maintained in order to prevent rebreathing of CO2. Furthermore, an increasing level of PEEP has been associated with a prolonged duration and improved quality of speech [5]. In case all expiratory flow passed through the oropharyngeal route, a Passy Muir® speaking valve (Passy Muir Inc., Irvine, USA) was installed in the circuit to enhance speech (Fig. 1). All 12 patients were able to speak in the first day after switching to the BiPAP setting, enabling effective communication with relatives and medical personnel. Quality and duration of speech improved over time. Effective weaning from MV was achieved in all patients by progressive intervals of CPAP. During CPAP the ability to speak was similar to that in the BiPAP mode. Median time from the beginning of speech to the end of MV was 12 ± 6 days.Table 1

View Article: PubMed Central - PubMed

Affiliation: Medical Center Leeuwarden, Leeuwarden, Netherlands.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

One way to enable speech in tracheotomised patients during the weaning period is to alternate MV with time-limited trials of cuff-deflated spontaneous breathing in combination a speaking valve... Although not commonly used, MV with deflated cuff in tracheotomised patients may be an alternative approach, and has been provided safely and comfortably in selected groups of non-ICU patients... Its use has been associated with improved swallowing and the possibility to speak... We describe our experiences to improve speech in tracheotomised ICU patients during cuff-deflated MV, in combination with a high flow non-invasive ventilator and a one-way tracheostomy speaking valve... Five patients were weaned from MV without the ability to speak, one patient died within 2 days after the tracheotomy, and one patient had persistent insufficient air leakage around the cannula, despite reduction in cannula size... A minimum PEEP level of 8 cmH2O was maintained in order to prevent rebreathing of CO2... Furthermore, an increasing level of PEEP has been associated with a prolonged duration and improved quality of speech... In case all expiratory flow passed through the oropharyngeal route, a Passy Muir speaking valve (Passy Muir Inc., Irvine, USA) was installed in the circuit to enhance speech (Fig.  1)... All 12 patients were able to speak in the first day after switching to the BiPAP setting, enabling effective communication with relatives and medical personnel... Quality and duration of speech improved over time... Median time from the beginning of speech to the end of MV was 12 ± 6 days... We conclude that in a selected group of difficult-to-wean tracheotomised ICU patients the ability to speak may effectively be restored by cuff-deflated non-invasive BiPAP ventilation in combination with a one-way speaking valve.

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