Austan F
University of Medicine and Dentistry of New Jersey, Respiratory Care Program, Camden.
Heart Lung. 1992 Nov-Dec;21(6):575-7.
To enable vocalization in a tracheostomized ventilator-assisted patient without compromising pulmonary status.
Case report.
University-affiliated nonprofit hospital.
A 62-year-old man with a medical history of metastatic lung cancer and chronic obstructive pulmonary disease received mechanical ventilation for 24 days. On the twenty-first day of ventilation the patient requested in writing the desire to vocalize with his family.
Flow-generated positive end-expiratory pressure of +3 cm of water (PEEP of 3 cm H2O) was applied to the patient's airway and the tracheostomy cuff was slowly deflated to create a cuff leak. The patient was instructed to phonate the letter /a/ until the sound became audible. Lack of voice intensity necessitated PEEP titration of 1 cm H2O increments until 8 cm H2O of PEEP intensified the voice.
During each session, the patient was able to vocalize clearly, without complications, as measured by the physiologic parameters: heart rate, respiratory rate, blood pressure, and oxygen saturation determined by oximetry.
