McGrath Brendan A, Wallace Sarah, Wilson Mark, Nicholson Leanne, Felton Tim, Bowyer Christine, Bentley Andrew M
Acute Intensive Care Unit, University Hospital South Manchester, Manchester, UK.
Department of Speech Voice & Swallowing, University Hospital South Manchester, Manchester, UK.
J Intensive Care Soc. 2019 Feb;20(1):59-65. doi: 10.1177/1751143718767055. Epub 2018 Mar 28.
Temporary tracheostomy is commonly used in patients admitted to intensive care units. Cuffed tubes prevent laryngeal airflow, preventing vocalisation. Sub-glottic suction tubes such as the 'Blue Line Ultra ' are used primarily to remove sub-glottic secretions, but retrograde gas flows via the suction port can facilitate above cuff vocalisation. The aims were to assess whether patients could achieve an audible voice using above cuff vocalisation, to demonstrate the safe use of the Blue Line Ultra tracheostomy tube for above cuff vocalisation, and to assess potential benefits of above cuff vocalisation for communication, secretion management and swallowing.
Our study (Reference 15/NW/0464, IRAS 178997) recruited adult intensive care unit patients who were alert, able to participate in an above cuff vocalisation trial and dependent on an inflated Blue Line Ultra cuff for ventilatory support. Consenting participants underwent fibreoptic endoscopic assessment of swallow by experienced Speech & Language Therapy staff with and without above cuff vocalisation. Clinical and fibreoptic endoscopic assessment of swallow, assessment of voice quality, swallowing and secretion management were recorded and scored. Median differences between paired observations and scores were analysed with and without above cuff vocalisation. Adverse events were identified by follow up fibreoptic endoscopic assessment of swallow and patient accounts.
Ten patients completed the study. Above cuff vocalisation was used for a median of 15 min, during a median of nine episodes, over a median of three days. Above cuff vocalisation resulted in an audible voice in eight of the 10 patients, during 66 out of 91 above cuff vocalisation attempts. There improvements in unstimulated dry cough and swallow frequency and aspiration ratings measured by fibreoptic endoscopic assessment of swallow. No complications were reported or observed in 66 attempts with only one episode terminated prematurely.
Above cuff vocalisation can achieve effective, safe, well-tolerated vocalisation in ventilator-dependant intensive care unit patients. Above cuff vocalisation has the potential to aid earlier, more effective communication and may improve laryngeal function and rehabilitation.
临时气管切开术常用于入住重症监护病房的患者。带套囊的气管导管可防止喉部气流，从而阻止发声。诸如“蓝线至尊”之类的声门下吸引管主要用于清除声门下分泌物，但通过吸引口的逆行气流可促进套囊上方发声。本研究旨在评估患者能否通过套囊上方发声发出可听见的声音，证明“蓝线至尊”气管切开导管用于套囊上方发声的安全性，并评估套囊上方发声在沟通、分泌物管理及吞咽方面的潜在益处。
我们的研究（参考文献15/NW/0464，IRAS 178997）招募了入住重症监护病房的成年患者，这些患者意识清醒，能够参与套囊上方发声试验，且依赖充气的“蓝线至尊”套囊进行通气支持。同意参与的患者在有或没有套囊上方发声的情况下，接受了由经验丰富的言语和语言治疗人员进行的纤维内镜吞咽评估。记录并评分吞咽的临床和纤维内镜评估、嗓音质量评估、吞咽及分泌物管理情况。分析有或没有套囊上方发声时配对观察结果和评分的中位数差异。通过后续纤维内镜吞咽评估和患者自述确定不良事件。
10名患者完成了研究。套囊上方发声的中位时长为15分钟，中位次数为9次，中位天数为3天。在10名患者中的8名患者身上，91次套囊上方发声尝试中有66次实现了可听见的声音。通过纤维内镜吞咽评估，未刺激时的干咳、吞咽频率及误吸评级均有改善。66次尝试中未报告或观察到并发症，仅1次提前终止。
套囊上方发声可在依赖呼吸机的重症监护病房患者中实现有效、安全且耐受性良好的发声。套囊上方发声有可能有助于更早、更有效的沟通，并可能改善喉部功能及康复情况。
