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Empowering tracheostomised ICU patients to speak

Critical care speech pathologist Anna-Liisa Sutt
Photo: Critical care speech pathologist Anna-Liisa Sutt
Critically ill patients are being given their voice back thanks to world-leading speech pathology research and practice in Queensland.

Invasively ventilated Intensive Care Unit (ICU) patients are now using the speaking valve on tracheostomy tubes to communicate with health professionals and family.

Previously, patients have been unable to speak due to the inflated tracheostomy cuff while widespread concerns about the potential negative impact on the patients’ recovering lungs often prevented patients from using the valves.

New research shows there is no evidence of lung de-recruitment while patients are weaning from mechanical ventilation. Instead, a recent study of 20 mostly cardiothoracic patients found speaking valve use actually improved patients’ lung function.
The Prince of Charles Hospital has become the first in the world to embrace the practice of using speaking valves with mechanically ventilated ICU patients, generating interest from hospitals nationally and world-wide.

Anna-Liisa Sutt, a critical care speech pathologist at Prince Charles Hospital and a University of Queensland School of Medicine clinical researcher, says her research was prompted while watching ICU patients struggling to speak.

“I noticed that all of these patients were really awake and alert and really trying to communicate, trying to mouth words across and these valves were never used,” she says.

“It just came across as a clinical question - why are we not using these valves with these patients?

“There was really no research to say that it was harmful for their lungs or that it wasn’t harmful. In medicine, it’s always ‘do no harm’ and we weren’t using them because it was feared they could be causing harm.”

Ms Sutt says it was the introduction of an innovative piece of equipment - Electrical Impedance Tomography (EIT), a radiation-free real-time bedside imaging tool, that enabled the hospital’s critical care research group to visualise patients’ lungs.

“My supervisor, Professor John Fraser, gave me an idea about this piece of equipment - that maybe we should use that to check how their lungs really are going with the speaking valve,” she says.

“This way, we didn’t have to take patients down to radiology and expose them to radiation.”

Funding from the Prince Charles Hospital Foundation and an NHMRC postgraduate research scholarship kick-started the novel project.

Ms Sutt’s study found all participants showed lung improvement while using the speaking valve.

“That was great - it was actually something that we didn’t expect,” she says.

“I think it’s just about really normalising the air flow. We are restoring that function for the body, the physiological positive end-expiratory pressure (PEEP) which helps maintain the lungs’ opening.

“It’s no longer just a ventilator or a breathing machine that’s supporting the patient's lungs - it’s their own body helping the lungs as well.”

Ms Sutt says communication is a major issue for ventilated patients - many find it distressing to be unable to speak.

Communication difficulties for these patients have also been linked to social withdrawal and can lead to depression, lack of motivation to participate in self-care, sleep deprivation and higher levels of anxiety and stress - which all impact on patient outcomes.

In addition, Ms Sutt says a questionnaire she conducted with ICU patients and nursing staff about patients’ communication success, before they used the speaking valve, found nurses often overestimate how much they understand their voiceless patients.

Ms Sutt says patients don’t plan their visit to ICU and by the time they receive a tracheostomy they’ve often been in ICU for at least a week.

“They’ve got so many questions - why are they in ICU, how much longer, and why are these things being done and not these?

“When patients get their voice back they are sometimes surprised, sometimes extremely happy, some of them obviously are really drowsy still and can’t tell the difference straight away but usually it’s just the best part of the day,” Ms Sutt says.

“It just empowers them and it empowers the family too because all of a sudden they are an active participant - they can ask things, give feedback on things, otherwise they were silently or trying desperately to say something which most of the time we didn’t understand.

“The day that I give someone back their voice, it’s the best part of my job, especially if the families are there too,” she says.

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Karen Keast

Karen Keast is a freelance health journalist who writes news and feature articles for HealthTimes.

Karen regularly writes for some of Australia’s leading health news websites and magazines.  In a media career spanning 20 years, Karen has worked as a senior journalist in newspapers and television. She has covered the grind of daily news and worked as a politics reporter at countless state and federal elections.

Since venturing into freelance writing five years ago, Karen has found her niche in writing about the health sector for editors, businesses and corporations.

Karen has interviewed the heads of peak health organisations in Australia and overseas, and written hundreds of news and feature articles covering the dedicated work of health professionals who tread the corridors of hospitals and health services, universities, aged care facilities and practices, day in and day out.

Follow Karen Keast on Twitter @stylemywords