Speech and Safety in Tracheostomy Patients Receiving Mechanical Ventilation: A Systematic Review

Vinciya Pandian, Sarah Boisen, Shifali Mathews, Michael J. Brenner

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To synthesize evidence of the safety and effectiveness of phonation in patients with fenestrated tracheostomy tubes. METHODS: 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. RESULTS: 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%]). CONCLUSIONS: 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.

Original languageEnglish (US)
Pages (from-to)441-450
Number of pages10
JournalAmerican journal of critical care : an official publication, American Association of Critical-Care Nurses
Volume28
Issue number6
DOIs
StatePublished - Nov 1 2019

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Tracheostomy
Artificial Respiration
Safety
Phonation
Subcutaneous Emphysema
Equipment and Supplies
Granulation Tissue
Acclimatization
Mechanical Ventilators
Quality Improvement
PubMed
Dyspnea

ASJC Scopus subject areas

  • Critical Care

Cite this

Speech and Safety in Tracheostomy Patients Receiving Mechanical Ventilation : A Systematic Review. / Pandian, Vinciya; Boisen, Sarah; Mathews, Shifali; Brenner, Michael J.

In: American journal of critical care : an official publication, American Association of Critical-Care Nurses, Vol. 28, No. 6, 01.11.2019, p. 441-450.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: To synthesize evidence of the safety and effectiveness of phonation in patients with fenestrated tracheostomy tubes. METHODS: 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. RESULTS: 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{\%}]). CONCLUSIONS: 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.",
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