Stephanie J. Scibilia is an inpatient adult speech-language pathologist, Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston, Massachusetts.
Sarah K. Gendreau is an inpatient adult speech-language pathologist, Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital.
Crit Care Nurse. 2022 Aug 1;42(4):38-46. doi: 10.4037/ccn2022405.
Communication impairment during mechanical ventilation and prolonged critical illness is extremely frustrating and frightening for patients and increases the risk for miscommunication, misinterpretation, and poor outcomes. The COVID-19 pandemic amplified patient communication impairment in intensive care units. This article presents 3 case examples from the experience of a team of hospital-based speech-language pathologists providing augmentative and alternative communication support resources and services to intensive care unit patients treated for COVID-19 during the first wave of the pandemic. Cases were selected to illustrate the protracted and complex in-hospital and rehabilitative recovery of critically ill patients with COVID-19, necessitating creative problem-solving and nursing collaborations with speech-language pathologists to support patient-provider communication.
The cases demonstrate (1) increased need for bilingual communication resources, (2) impaired cognitive and motor function associated with a variety of post-COVID-19 sequelae including severe critical illness myopathy, and (3) delayed transition to a speaking valve due to the secretion burden.
COVID-19 and acute respiratory distress syndrome (all), cerebral microhemorrhage, multi-system organ failure, hypoxic brain injury, altered mental status, seizure, stroke.
Multimodal and progressive augmentative and alternative communication interventions included low-technology strategies and simple communication boards, video language interpretation, tracheostomy speaking strategies, and a video intercom system.
All patients made progressive gains in communication ability.
Evaluation by augmentative and alternative communication specialists and progressive intervention from speech-language pathologists in collaboration with intensive care unit nurses can greatly improve patient-provider communication during treatment for and recovery from COVID-19 and other prolonged critical illnesses.
在机械通气和长时间重症监护期间，交流障碍对患者来说是极其令人沮丧和恐惧的，增加了沟通错误、误解和不良结局的风险。COVID-19 大流行放大了重症监护病房患者的交流障碍。本文介绍了一个由医院基础语言病理学家组成的团队在 COVID-19 大流行第一波期间为 COVID-19 患者提供补充和替代交流支持资源和服务时所经历的 3 个病例。这些病例是为了说明患有 COVID-19 的重症患者在医院和康复过程中时间延长且复杂，需要创造性地解决问题并与语言病理学家合作，以支持医患沟通。
这些病例表明（1）需要更多的双语交流资源，（2）与多种 COVID-19 后遗症相关的认知和运动功能受损，包括严重的危重病性肌病，以及（3）由于分泌物负担而导致说话阀的延迟转换。
COVID-19 和急性呼吸窘迫综合征（全部）、脑微出血、多系统器官衰竭、缺氧性脑损伤、精神状态改变、癫痫发作、中风。
多模式和渐进性补充和替代交流干预措施包括低技术策略和简单的交流板、视频语言翻译、气管造口术说话策略和视频对讲机系统。
所有患者在交流能力方面都取得了进展。
补充和替代交流专家的评估以及与重症监护病房护士合作的语言病理学家的渐进式干预可以极大地改善 COVID-19 和其他长时间重症疾病的治疗和康复期间的医患沟通。
