Ventilator-assisted patient vocalization with positive end-expiratory pressure and tracheostomy cuff leak: a brief report.

OBJECTIVE

To enable vocalization in a tracheostomized ventilator-assisted patient without compromising pulmonary status.

DESIGN

Case report.

SETTING

University-affiliated nonprofit hospital.

PATIENT

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.

INTERVENTION

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.

CONCLUSION

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.