| TITLE |
| Implementing Above Cuff Vocalisation (ACV) on our Intensive Care Unit – Speaking with a cuffed tracheostomy whilst on a ventilator |
| BACKGROUND |
Patients on the Intensive Care Unit (ICU), who are currently ventilator–dependant through a tracheostomy tube (cuff-inflated), usually cannot speak. Oxygen insufflated via the subglottic suction line of the tracheostomy tube flows across the vocal cords and can facilitate speech.  |
| METHODS |
| We saw a presentation on ACV at a National Conference, reviewed literature1.2.3, liaised with a few centres practicing ACV, discussed in our Working Group, adapted a model for our ICU and performed a feasibility trial on 10 patients |
| RESULTS |
| The speech quality varied from a whisper to clear sound. We unmasked the cause of agitation in a few patients (tactile and visual hallucinations). Noticed a change in staff attitudes from being sceptical initially to actively seeking a trial of ACV for patients. No side effects / complications were seen. We recorded a video of ACV on one of our patients (with their consent) We have presented our findings in our directorate, written a Standard Operating Procedure for our ICU with an aim to implement ACV in all tracheostomy patients (with no contraindications) |
| DISCUSSION |
| ACV, a simple technique, can be used in any patient with a tracheostomy (with a subglottic suction port), which is more than 72 hrs old, no upper airway obstruction and no ongoing issues (bleeding, infection) Risk of harm is low3 (two reports of brief surgical emphysema that fully recovered, one report of wrong connection of oxygen to cuff pilot balloon causing cuff rupture, nausea, strained voice etc) Potential benefits include reduction of anxiety, agitation, delirium, quicker weaning of sedation and ventilation and improved patient satisfaction with some evidence of improved swallowing3. |
| ACKNOWLEDGEMENTS |
| REFERENCES Brendan McGrath et al. Above cuff vocalisation: A novel technique for communication in the ventilator-dependent tracheostomy patient. Journal of the Intensive Care Society 2016 Feb; 17 (1): 19-26Brendan McGrath et al. Safety and feasibility of above cuff vocalisation for ventilator-dependent patient with tracheostomies. Journal of the Intensive Care Society 2019 Feb; 20(1): 59-65Claire S Mills et al. Evidence for Above Cuff Vocalization in Patients With a Tracheostomy: A Systematic Review Laryngoscope 2022; 132: 600–611 |
