Speech Pathology Department, Austin Health, Melbourne, Australia.
Centre for Neuroscience of Speech, The University of Melbourne, Australia.
Am J Speech Lang Pathol. 2019 Aug 9;28(3):1335-1355. doi: 10.1044/2019_AJSLP-19-0001. Epub 2019 Jul 11.
Purpose The aim of this study was to conduct a systematic review of the literature relating to the feasibility, utility, and safety of augmentative and alternative communication (AAC) interventions and tracheostomy-related communication interventions with mechanically ventilated adult patients in the intensive care unit (ICU). Method MEDLINE, Embase, and PsycINFO databases were searched for relevant articles. Studies were included if (a) they were performed in the ICU, (b) they involved participants > 18 years of age, (c) > 85% of participants were mechanically ventilated, and (d) they reported on content that related to the feasibility and/or utility and/or safety of AAC intervention and/or tracheostomy-related communication intervention. Studies were extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The levels of evidence for included studies were assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines. Results Forty-eight studies met the inclusion criteria. Different communication interventions relating to intubated and tracheostomized mechanically ventilated patients were reviewed, including (a) communication boards, (b) electrolarynx, (c) high-technology AAC devices, (d) tracheostomy tubes with communication-enabling features, (e) one-way valve in line with the ventilator, (f) ventilator-adjusted leak speech, (g) ventilator adjustments and one-way valve, and (h) multiple interventions. Forty-seven of 48 studies examined the feasibility and utility of the interventions. Sixteen studies examined the safety of the interventions. The included studies were composed of randomized controlled trials (n = 2), quasi-experimental studies (n = 7), cohort studies (n = 8), case-control (n = 1), case series (n = 23), and case reports (n = 7). The levels of evidence varied and ranged from high (n = 2), moderate (n = 7), low (n = 9), and very low (n = 30). Conclusions There is developing evidence that communication interventions with mechanically ventilated ICU patients are feasible, have utility, and are safe. Further research is warranted to guide speech pathologist-directed intervention to improve patient outcomes and the patient experience in the ICU.
目的 本研究旨在对与 ICU 中机械通气的成年患者的可行性、实用性和安全性相关的辅助和替代沟通（AAC）干预措施和气管造口相关沟通干预措施的文献进行系统综述。
方法 检索了 MEDLINE、Embase 和 PsycINFO 数据库中相关的文章。符合以下标准的研究被纳入：（a）在 ICU 中进行，（b）参与者年龄> 18 岁，（c）> 85%的参与者接受机械通气，（d）报告了与 AAC 干预措施和/或气管造口相关沟通干预措施的可行性和/或实用性和/或安全性相关的内容。研究根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行提取。纳入研究的证据水平使用推荐评估、制定和评估（GRADE）指南进行评估。
结果 48 项研究符合纳入标准。回顾了与气管插管和气管造口机械通气患者相关的不同沟通干预措施，包括（a）沟通板，（b）电子喉，（c）高科技 AAC 设备，（d）带沟通功能的气管造口管，（e）与呼吸机相连的单向阀，（f）呼吸机调整后的漏气语音，（g）呼吸机调整和单向阀，（h）多种干预措施。48 项研究中的 47 项研究检查了干预措施的可行性和实用性。16 项研究检查了干预措施的安全性。纳入的研究包括随机对照试验（n = 2）、准实验研究（n = 7）、队列研究（n = 8）、病例对照研究（n = 1）、病例系列研究（n = 23）和病例报告（n = 7）。证据水平各不相同，包括高（n = 2）、中（n = 7）、低（n = 9）和极低（n = 30）。
结论 有越来越多的证据表明，与 ICU 中机械通气的患者进行沟通干预是可行的、实用的且安全的。需要进一步的研究来指导言语病理学家指导的干预措施，以改善患者的结局和 ICU 患者的体验。
