Ten Hoorn S, Elbers P W, Girbes A R, Tuinman P R
Department of Intensive Care Medicine and Research VUmc Intensive Care (REVIVE), VU University Medical Center Amsterdam, Room ZH-7D-166, De Boelelaan 1117, PO Box 7057, Amsterdam, 1007 MB, The Netherlands.
Institute for Cardiovascular Research VU (ICaR-VU), VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
Crit Care. 2016 Oct 19;20(1):333. doi: 10.1186/s13054-016-1483-2.
Ventilator-dependent patients in the ICU often experience difficulties with one of the most basic human functions, namely communication, due to intubation. Although various assistive communication tools exist, these are infrequently used in ICU patients. We summarized the current evidence on communication methods with mechanically ventilated patients in the ICU. Secondly, we developed an algorithm for communication with these patients based on current evidence.
We performed a systematic review. PubMed, Embase, Cochrane, Cinahl, PsychInfo, and Web of Science databases were systematically searched to November 2015. Studies that reported a communication intervention with conscious nonverbal mechanically ventilated patients in the ICU aged 18 years or older were included. The methodological quality was assessed using the Quality Assessment Tool.
The search yielded 9883 publications, of which 31 articles, representing 29 different studies, fulfilled the inclusion criteria. The overall methodological quality varied from poor to moderate. We identified four communication intervention types: (1) communication boards were studied in three studies-they improved communication and increased patient satisfaction, but they can be time-consuming and limit the ability to produce novel utterances; (2) two types of specialized talking tracheostomy tubes were assessed in eight studies-audible voicing was achieved in the majority of patients (range 74-100 %), but more studies are needed to facilitate safe and effective use; (3) an electrolarynx improved communication in seven studies-its effectiveness was mainly demonstrated with tracheostomized patients; and (4) "high-tech" augmentative and alternative communication (AAC) devices in nine studies with diverse computerized AAC devices proved to be beneficial communication methods-two studies investigated multiple AAC interventions, and different control devices (e.g., touch-sensitive or eye/blink detection) can be used to ensure that physical limitations do not prevent use of the devices. We developed an algorithm for the assessment and selection of a communication intervention with nonverbal and conscious mechanically intubated patients in the ICU.
Although evidence is limited, results suggest that most communication methods may be effective in improving patient-healthcare professional communication with mechanically ventilated patients. A combination of methods is advised. We developed an algorithm to standardize the approach for selection of communication techniques.
重症监护病房（ICU）中依赖呼吸机的患者由于插管常常在人类最基本的功能之一即沟通方面遇到困难。尽管存在各种辅助沟通工具，但这些工具在ICU患者中很少使用。我们总结了目前关于ICU中机械通气患者沟通方法的证据。其次，我们根据现有证据开发了一种与这些患者沟通的算法。
我们进行了一项系统评价。系统检索了截至2015年11月的PubMed、Embase、Cochrane、Cinahl、PsychInfo和Web of Science数据库。纳入了报告对18岁及以上ICU中清醒的非言语机械通气患者进行沟通干预的研究。使用质量评估工具评估方法学质量。
检索共获得9883篇出版物，其中31篇文章（代表29项不同研究）符合纳入标准。总体方法学质量从差到中等不等。我们确定了四种沟通干预类型：（1）三项研究对沟通板进行了研究——它们改善了沟通并提高了患者满意度，但可能耗时且限制了产生新话语的能力；（2）八项研究评估了两种类型的专门的可发声气管造口管——大多数患者实现了可发声（范围为74%-100%），但需要更多研究以促进安全有效使用；（3）七项研究表明电子喉改善了沟通——其有效性主要在气管造口患者中得到证实；（4）九项研究中使用了各种计算机化的“高科技”辅助和替代沟通（AAC）设备，结果证明这些是有益的沟通方法——两项研究调查了多种AAC干预措施，并且可以使用不同的控制设备（如触摸感应或眼睛/眨眼检测）以确保身体限制不会妨碍设备的使用。我们开发了一种算法，用于评估和选择对ICU中无言语能力且清醒的机械插管患者的沟通干预措施。
尽管证据有限，但结果表明大多数沟通方法可能有效改善患者与医护人员之间与机械通气患者的沟通。建议采用多种方法结合。我们开发了一种算法以规范沟通技术选择的方法。
