Vinciya Pandian is an associate professor, Johns Hopkins School of Nursing, Baltimore, Maryland. Sarah Boisen is an intensive care unit nurse, The Johns Hopkins Hospital, Baltimore, Maryland. Shifali Mathews is a BS student and research assistant, Johns Hopkins School of Nursing. Michael J. Brenner is an associate professor, Department of Otolaryngology-Head & Neck Surgery, Michigan Medicine-University of Michigan, Ann Arbor, Michigan.
Am J Crit Care. 2019 Nov;28(6):441-450. doi: 10.4037/ajcc2019892.
To synthesize evidence of the safety and effectiveness of phonation in patients with fenestrated tracheostomy tubes.
PubMed, CINAHL, Scopus, Cochrane, and Web of Science databases were searched. The research question was, "Are fenestrated tracheostomy tubes a safe and effective option to facilitate early phonation in patients undergoing tracheostomy?" Studies of fenestrated tracheostomy tubes were assessed for risk of bias and quality of evidence. Data were abstracted, cross-checked for accuracy, and synthesized.
Of the 160 studies identified, 13 met inclusion criteria, including 6 clinical studies (104 patients), 6 case reports (13 patients), and 1 nationwide clinician survey. The primary indications for a tracheostomy were chronic ventilator dependence (83%) and airway protection (17%). Indications for fenestrated tracheostomy included inaudible phonation and poor voice intelligibility. Patients with fenestrated tubes achieved robust voice outcomes. Complications included granulation tissue (6 patients [5%]), malpositioning (1 patient [0.9%]), decreased oxygen saturation (3 patients [2.6%]), increased blood pressure (1 patient [0.9%]), increased peak pressures (2 patients [1.7%]), and air leakage (1 patient [0.9%]); subcutaneous emphysema also occurred frequently. Patient-reported symptoms included shortness of breath (4 patients [3.4%]), anxiety (3 patients [2.6%]), and chest discomfort (1 patient [0.9%]).
Fenestrated devices afford benefits for speech and decannulation but carry risks of granulation, aberrant airflow, and acclimation challenges. Findings highlight the need for continued innovation, education, and quality improvement around the use of fenestrated devices.
综合评估带孔气管切开套管在气管切开患者发声方面的安全性和有效性。
检索了 PubMed、CINAHL、Scopus、Cochrane 和 Web of Science 数据库。研究问题是“带孔气管切开套管是否是一种安全有效的选择，可促进气管切开术后患者早期发声？”对带孔气管切开套管的研究进行了偏倚风险评估和证据质量评估。提取数据，交叉检查准确性，并进行综合分析。
在确定的 160 项研究中，有 13 项符合纳入标准，包括 6 项临床研究（104 例患者）、6 项病例报告（13 例患者）和 1 项全国性临床医生调查。气管切开的主要指征是慢性呼吸机依赖（83%）和气道保护（17%）。带孔气管切开的指征包括发音不清和语音清晰度差。带孔套管的患者获得了良好的发声效果。并发症包括肉芽组织（6 例[5%]）、错位（1 例[0.9%]）、血氧饱和度降低（3 例[2.6%]）、血压升高（1 例[0.9%]）、峰值压力升高（2 例[1.7%]）和空气泄漏（1 例[0.9%]）；皮下气肿也很常见。患者报告的症状包括呼吸急促（4 例[3.4%]）、焦虑（3 例[2.6%]）和胸部不适（1 例[0.9%]）。
带孔器械有利于言语和拔管，但存在肉芽组织形成、气流异常和适应挑战的风险。研究结果强调了在带孔器械的使用方面需要持续创新、教育和质量改进。
