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Foran SJ, Taran S, Singh JM, Kutsogiannis DJ, McCredie V. Timing of tracheostomy in acute traumatic spinal cord injury: A systematic review and meta-analysis. J Trauma Acute Care Surg 2022; 92:223-231. [PMID: 34508010 PMCID: PMC8677619 DOI: 10.1097/ta.0000000000003394] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/04/2021] [Accepted: 08/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with acute traumatic cervical or high thoracic level spinal cord injury (SCI) typically require mechanical ventilation (MV) during their acute admission. Placement of a tracheostomy is preferred when prolonged weaning from MV is anticipated. However, the optimal timing of tracheostomy placement in patients with acute traumatic SCI remains uncertain. We systematically reviewed the literature to determine the effects of early versus late tracheostomy or prolonged intubation in patients with acute traumatic SCI on important clinical outcomes. METHODS Six databases were searched from their inception to January 2020. Conference abstracts from relevant proceedings and the gray literature were searched to identify additional studies. Data were obtained by two independent reviewers to ensure accuracy and completeness. The quality of observational studies was evaluated using the Newcastle Ottawa Scale. RESULTS Seventeen studies (2,804 patients) met selection criteria, 14 of which were published after 2009. Meta-analysis showed that early tracheostomy was not associated with decreased short-term mortality (risk ratio [RR], 0.84; 95% confidence interval [CI], 0.39-1.79; p = 0.65; n = 2,072), but was associated with a reduction in MV duration (mean difference [MD], 13.1 days; 95% CI, -6.70 to -21.11; p = 0.0002; n = 855), intensive care unit length of stay (MD, -10.20 days; 95% CI, -4.66 to -15.74; p = 0.0003; n = 855), and hospital length of stay (MD, -7.39 days; 95% CI, -3.74 to -11.03; p < 0.0001; n = 423). Early tracheostomy was also associated with a decreased incidence of ventilator-associated pneumonia and tracheostomy-related complications (RR, 0.86; 95% CI, 0.75-0.98; p = 0.02; n = 2,043 and RR, 0.64; 95% CI, 0.48-0.84; p = 0.001; n = 812 respectively). The majority of studies ranked as good methodologic quality on the Newcastle Ottawa Scale. CONCLUSION Early tracheostomy in patients with acute traumatic SCI may reduce duration of mechanical entilation, length of intensive care unit stay, and length of hospital stay. Current studies highlight the lack of high-level evidence to guide the optimal timing of tracheostomy in acute traumatic SCI. Future research should seek to understand whether early tracheostomy improves patient comfort, decreases duration of sedation, and improves long-term outcomes. LEVEL OF EVIDENCE Systematic Review, level III.
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Standard versus Accelerated Speaking Valve Placement after Percutaneous Tracheostomy: A Randomized-Controlled Feasibility Study. Ann Am Thorac Soc 2021; 18:1693-1701. [PMID: 33760713 DOI: 10.1513/annalsats.202010-1282oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Feasibility of a large, multi-center, randomized controlled trial (RCT) comparing the risks and benefits of early use speaking valve following tracheostomy is not clear. OBJECTIVE To investigate the feasibility of accelerated (≤ 24 hours) versus standard (≥ 48 hours) one-way speaking valve ("speaking valve") placement after percutaneous tracheostomy. METHOD Twenty awake patients (Glasgow Coma Scale score >9) were randomized to accelerated or standard timing of speaking valve placement. Outcomes included patient identification and recruitment, adherence to protocol-defined time windows for valve placement, experimental separation in time to first speaking valve placement between groups, effectiveness of speech and swallowing (sentence intelligibility test [SIT] score, patient-reported quality of life [QOL]), and clinical outcomes (safety events, speaking valve tolerance, decannulation, length of stay, mortality). RESULTS Of 161 patients undergoing percutaneous tracheostomy, 20 of 36 meeting eligibility criteria were randomized. The median time to speaking valve placement was 22 (IQR: 21, 23) hours in the accelerated arm versus 45.5 (IQR: 43, 50) hours for the standard arm. No aspiration, hypoxemia, or other safety events occurred in either arm as a result of the speaking valve. SIT scores were not different between arms but correlated with QOL. After 3 sessions, patients in the accelerated arm tolerated longer speaking valve trials than the standard arm [Median (IQR): 65 (45 - 720) vs. 15 (3-20) minutes]. Seven patients in the accelerated arm were decannulated before hospital discharge versus one patient in the standard arm. CONCLUSIONS Speaking valve placement within 24 hours of percutaneous tracheostomy is feasible. A multicenter, randomized, control trial should be conducted to evaluate the safety of this strategy and compare important clinical outcomes, including time to speech and swallow recovery following tracheostomy. Clinical trial registered with ClinicalTrials.gov (NCT03008174).
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Lewandowska K, Małkiewicz MA, Siemiński M, Cubała WJ, Winklewski PJ, Mędrzycka-Dąbrowska WA. The role of melatonin and melatonin receptor agonist in the prevention of sleep disturbances and delirium in intensive care unit - a clinical review. Sleep Med 2020; 69:127-134. [PMID: 32074506 DOI: 10.1016/j.sleep.2020.01.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/16/2019] [Accepted: 01/15/2020] [Indexed: 12/19/2022]
Abstract
AIM The intensive care unit (ICU) environment contributes to the development of sleep disturbances. Sleep disturbances, sleep fragmentation, and multiple awakening episodes lead to the circadian rhythm disorder, which increases the risk of delirium. Melatonin and melatonin receptor agonist is widely used agent in the therapy of sleep disturbances. However, there is also some for its efficacy in ICU delirium. Enteral melatonin and ramelteon supplementation eliminates (partially) the delirium inducing factors. METHODS PubMed/MEDLINE, OVID, Embase, Cochrane Library, and Web of Science databases were searched using adequate key words. We reviewed the literature on the role of melatonin and ramelteon in the prevention of sleep disturbances and delirium in intensive care units and analysed the methods of melatonin therapy in an ICU setting. Review followed the PRISMA statement. A review written protocol was not drafted. RESULTS Originally 380 studies were searched in five scientific databases. After rejecting the duplicate results, 125 results were obtained. Finally, 10 scientific studies were included in the review. In selected articles, the leading topics analysed were the role of melatonin and ramelteon in the prevention of delirium and sleep disorders. In addition, the noted effect of therapy with these agents on reducing the ventilation time of mechanical time and the demand for psychoactive substances in the ICU environment. CONCLUSION Reduction of either the incidence or the severity of delirium course is possible by eliminating its risk factors. Risk factors are directly related to sleep disorders. To reduce the problem, therefore, a holistic approach to the source is necessary. The efficacy of melatonin therapy in an ICU setting requires confirmation in studies including a greater number of participants as the impact of melatonin on these factors is yet to be fully elucidated. However, the prognosis is predictive because this concept provides patients with a minimally invasive and natural form of therapy.
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Affiliation(s)
- Katarzyna Lewandowska
- Department of Anaesthesiology Nursing and Intensive Care, Medical University of Gdansk, Gdansk, Poland
| | - Marta A Małkiewicz
- Department of Human Physiology, Medical University of Gdansk, Gdansk, Poland; Department of Psychiatry, Medical University of Gdansk, Gdansk, Poland
| | - Mariusz Siemiński
- Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Wiesław J Cubała
- Department of Psychiatry, Medical University of Gdansk, Gdansk, Poland
| | - Paweł J Winklewski
- Department of Human Physiology, Medical University of Gdansk, Gdansk, Poland; Department of Clinical Anatomy and Physiology, Pomeranian University of Slupsk, Slupsk, Poland
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Pandian V, Cole T, Kilonsky D, Holden K, Feller-Kopman DJ, Brower R, Mirski M. Voice-Related Quality of Life Increases With a Talking Tracheostomy Tube: A Randomized Controlled Trial. Laryngoscope 2019; 130:1249-1255. [PMID: 31385620 DOI: 10.1002/lary.28211] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/01/2019] [Accepted: 07/10/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The primary objective of our study was to determine the quality of life (QOL) using a talking tracheostomy tube. METHODS Randomized clinical trial (NCT2018562). Adult intensive care unit patients who were mechanically ventilated, awake, alert, attempting to communicate, English-speaking, and could not tolerate one-way speaking valve were included. Intervention comprised a Blue Line Ultra Suctionaid (BLUSA) talking tracheostomy tube (Smiths Medical, Dublin, OH, US). Outcome measures included QOL scores measured using Quality of Life in Mechanically Ventilated Patients (QOL-MV) and Voice-Related Quality of Life (V-RQOL), Speech Intelligibility Test (SIT) scores, independence, and satisfaction. RESULTS The change in V-RQOL scores from pre- to postintervention was higher among patients using a BLUSA (Smiths Medical) compared to those who did not (P = 0.001). The QOL-MV scores from pre- to postintervention were significantly higher among patients who used a BLUSA (Smiths Medical) compared to patients who did not use BLUSA (Smiths Medical) or a one-way speaking valve (P = 0.04). SIT scores decreased by 6.4 points for each 1-point increase in their Sequential Organ Failure Assessment scores (P = 0.04). The overall QOL-MV scores correlated moderately with the overall V-RQOL scores (correlation coefficient = 0.59). Cronbach alpha score for overall QOL-MV was 0.71. Seventy-three percent of the 22 intervention patients reported the ability to use the BLUSA (Smiths Medical) with some level of independence, whereas 41% reported some level of satisfaction with the use of BLUSA (Smiths Medical). The lengths of stay was longer in the intervention group. CONCLUSION Our study suggests that BLUSA (Smiths Medical) talking tracheostomy tube improves patient-reported QOL in mechanically ventilated patients with a tracheostomy who cannot tolerate cuff deflation. LEVEL OF EVIDENCE I Laryngoscope, 130:1249-1255, 2020.
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Affiliation(s)
| | - Therese Cole
- The Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
| | - Dana Kilonsky
- The Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
| | - Kate Holden
- The Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
| | | | - Roy Brower
- The Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
| | - Marek Mirski
- The Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
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Winck JC, Gilet H, Kalin P, Murcia J, Plano F, Regnault A, Dreher M, Vitacca M, Ambrosino N. Validation of the Multi-INdependence Dimensions (MIND) questionnaire for prolonged mechanically ventilated subjects. BMC Pulm Med 2019; 19:109. [PMID: 31221129 PMCID: PMC6585039 DOI: 10.1186/s12890-019-0870-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 06/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background Evaluating severity of illness of patients with prolonged mechanical ventilation (PMV) is important to adopt the best appropriate care management for each individual. Yet, no severity-of-illness scoring system has been specifically designed for this type of patients. The aim of this study was to develop and validate a new instrument, the Multi-INdependence Dimensions (MIND) questionnaire designed to comprehensively measure the severity of illness of patients under PMV. Methods The validation of the MIND questionnaire was performed during a longitudinal observational study conducted with PMV subjects in weaning facilities in three countries (Argentina, Colombia and Germany). The questionnaire validity was tested in 3 stages: 1) Specification of components, with description of item responses, inter-item and Cronbach alpha correlations; 2) Creation of the composite scores; 3) Measurement properties determination including test-retest reliability after 30 days, clinical validity (Medical Research Council (MRC) muscle strength score, Sepsis-related Organ Failure Assessment (SOFA), Glasgow Coma Scale (GCS), Dependence Nursing Scale and EuroQol-5 Dimension evaluated at inclusion), and ability to detect change. Results A total of 128 subjects participated in the validation study. Eleven component scores and four composite scores were created. MIND scores significantly correlated with MRC muscle strength, SOFA, DNS, GCS and EQ-5D, supporting the validity of the new scores. Intraclass Correlation Coefficient greater than 0.82 were observed for all composite scores, indicating good test-retest reliability. MIND scores were able to detect improvement in subject severity of illness. Conclusion The MIND questionnaire is a valid and reliable instrument for measuring comprehensively the multiple dimensions characterizing the severity of illness of PMV patients. Trial registration NCT02255058. Electronic supplementary material The online version of this article (10.1186/s12890-019-0870-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joao C Winck
- Linde AG, Linde Healthcare, Pullach, Germany. .,Present Address : Faculty of Medicine, University of Porto, Porto, Portugal.
| | | | - Peter Kalin
- Linde Gas Therapeutics GmbH, Linde Healthcare, Oberschleissheim, Germany
| | - Javier Murcia
- Division Homecare Linde Healthcare, Bogota, Colombia
| | - Fabian Plano
- REMEO Center Pilar, Linde Group, Buenos Aires, Argentina
| | | | - Michael Dreher
- Division of Pneumology, Angiology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Michele Vitacca
- Respiratory and Rehabilitation Division, ICS Maugeri, IRCCS, Lumezzane, Italy
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Bashar FR, Vahedian-Azimi A, Salesi M, Hajiesmaeili M, Shojaei S, Farzanegan B, Goharani R, Madani SJ, Moghaddam KG, Hatamian S, Moghaddam HJ, Arrascaeta-Llanes A, Miller AC. Spiritual Health and Outcomes in Muslim ICU Patients: A Nationwide Cross-Sectional Study. JOURNAL OF RELIGION AND HEALTH 2018; 57:2241-2257. [PMID: 29299787 DOI: 10.1007/s10943-017-0543-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of the present study is to describe how religiosity and spirituality affect the psychiatric morbidity of Muslim intensive care unit (ICU) patients. We conducted a prospective nationwide cross-sectional study of ICU patients discharged from 45 medical centers spanning 31 proivinces in Iran. Adults (age ≥ 18 years) admitted to the ICU and treated with invasive mechanical ventilation were eligible. Nine validated survey tools were administered to detect direct and indirect associations between spiritual health (SH) and depression, anxiety, and post-traumatic disorder. The Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale-Revised (IES-R), Post-Traumatic Stress Syndrome 14 question (PTSS-14) quality-of-life (QoL), and quality of patient to physician or nurse communication (PP-QoC and PN-QoC) scales were modeled through two mediators by structural equation modeling (SEM). Sex, ICU type, LOS, and APACHE II score were added in the independent variable list. 338 eligible patients were discharged from the ICUs during the study period. 56 were excluded (clinical status), and 282 were administered the survey. 278 returned it, with 272 complete and 6 partial responses. SH displayed no direct or indirect association to QoL. SH was indirectly associated with decreased depression and anxiety (B = - 0.081, p < 0.05) via PP-QoC mediator. Both direct and indirect positive associations were observed between SH and IES-R (B = 0.293, p < 0.05; via PP-QoC) and PTSS-14 scores (B = 0.267, p < 0.001; via PP-QoC). Medical ICU location was associated with decreased PTSS-14 scores via the same mediator. In this survey of Muslim ICU patients treated with invasive mechanical ventilation, SH correlated with decreased depression and anxiety, but paradoxically increased post-traumatic stress. The most influential mediator was patient-physician quality-of-communication.
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Affiliation(s)
- Farshid R Bashar
- Anesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamedan, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mahmood Salesi
- Research Center for Prevention of Oral and Dental Disease, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Hajiesmaeili
- Anesthesiology Research Center, Anesthesia and Critical Care Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedpouzhia Shojaei
- Anesthesiology Research Center, Anesthesia and Critical Care Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrooz Farzanegan
- Tracheal Diseases Research Center, Anesthesia and Critical Care Department, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Goharani
- Anesthesiology Research Center, Anesthesia and Critical Care Department, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed J Madani
- Trauma Research Center, Medicine Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Kivan G Moghaddam
- Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sevak Hatamian
- Anesthesia and Critical Care Department, Alborz University of Medical Sciences, Karaj, Iran
| | - Hosseinali J Moghaddam
- Anesthesia Care Department, Anesthesiology Research Center, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Andrew C Miller
- Department of Emergency Medicine, Vidant Medical Center, East Carolina University Brody School of Medicine, 600 Moye Blvd, Greenville, NC, 27834, USA.
- Department of Emergency Medicine, J.W. Ruby Memorial Hospital, West Virginia University, Morgantown, WV, USA.
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Freeman-Sanderson AL, Togher L, Elkins M, Kenny B. Quality of life improves for tracheostomy patients with return of voice: A mixed methods evaluation of the patient experience across the care continuum. Intensive Crit Care Nurs 2018; 46:10-16. [PMID: 29551223 DOI: 10.1016/j.iccn.2018.02.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 02/01/2018] [Accepted: 02/06/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES A tracheostomy tube can profoundly impact ability to communicate. The impact of this on patients' self-esteem and quality of life in the care continuum from the intensive care unit to after decannulation has not been reported. Therefore, the aim was to investigate the patient-reported experience regarding change in communication function, communication-related self-esteem and quality of life. RESEARCH DESIGN A mixed methods approach was utilised. Quantitative data were obtained using validated measures of self-esteem related to communication-related quality of life and general health. Data were measured before return of voice, within 48 hours of voice return and six months after tracheostomy decannulation. Qualitative data were collected through structured interviews six months after tracheostomy. RESULTS Seventeen participants completed the study. Four themes emerged from the interviews: It's hard communicating without a voice; What is happening to me?; A storm of dark emotions and More than a response…it's participating and recovering. Significant positive change occurred in six items of self-esteem related to communication from baseline to return of voice. Overall, positive changes in quality of life scores were observed. CONCLUSIONS Voice loss with tracheostomy significantly affected participants' abilities to effectively communicate their care and comfort needs. Restoration of voice occurred in conjunction with patient-reported improved mood, outlook and sense of recovery.
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Affiliation(s)
- Amy L Freeman-Sanderson
- Royal Prince Alfred Hospital, Australia; Faculty of Health Sciences University of Sydney, Australia.
| | - Leanne Togher
- Faculty of Health Sciences University of Sydney, Australia
| | - Mark Elkins
- Sydney Medical School, University of Sydney, Australia; Centre for Education & Workforce Development, Sydney Local Health District, Australia
| | - Belinda Kenny
- Faculty of Health Sciences University of Sydney, Australia
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Smith KA, Bosch JD, Pelletier G, MacKenzie M, Hoy MY. The Development of a Tracheostomy-Specific Quality of Life Questionnaire. Ann Otol Rhinol Laryngol 2016; 125:667-71. [DOI: 10.1177/0003489416644619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: A long-term tracheostomy can be a life-altering event and can have significant effects on patients’ quality of life (QOL). There is currently no instrument available to evaluate tracheostomy-specific QOL. To address this deficiency, the objective of this study was to create and preliminarily validate a pilot tracheostomy-specific QOL questionnaire to assess its feasibility. Methods: A multidisciplinary team developed the pilot tracheostomy-specific QOL questionnaire (TQOL) in 3 phases: item generation, item review, and scale construction. The survey was administered at 0 and 2 weeks to a pilot group of tracheostomy patients with concurrent administration of a validated general QOL questionnaire at week 0. Convergence validity, test-retest reliability, and internal consistency were the primary outcome measures. Results: A total of 37 patients completed the study (mean tracheostomy duration = 90 weeks). The convergence validity of the TQOL was moderately strong ( r = 0.72), and the test-retest reliability was strong ( r = 0.75). The TQOL also demonstrated good internal consistency (Cronbach’s alpha = 0.82). Conclusion: The TQOL has moderately strong internal consistency, convergence validity, and test-retest reliability. While additional refinement and validation may improve the questionnaire, these initial results are promising and support further development of this tool.
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Affiliation(s)
- Kristine A. Smith
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery; University of Calgary, Calgary, AB, Canada
| | - John Douglas Bosch
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery; University of Calgary, Calgary, AB, Canada
| | - Guy Pelletier
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Marianne MacKenzie
- Department of Respiratory Technology, Alberta Health Services, Calgary, AB, Canada
| | - Monica Y. Hoy
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery; University of Calgary, Calgary, AB, Canada
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Freeman-Sanderson AL, Togher L, Elkins MR, Phipps PR. Quality of life improves with return of voice in tracheostomy patients in intensive care: An observational study. J Crit Care 2016; 33:186-91. [PMID: 26971032 DOI: 10.1016/j.jcrc.2016.01.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To measure patient-reported change of mood, communication-related quality of life, and general health status with return of voice among mechanically ventilated tracheostomy patients admitted to the intensive care unit (ICU). MATERIALS AND METHODS A prospective observational study in a tertiary ICU was conducted. Communication-related quality of life was measured daily using the Visual Analogue Self-Esteem Scale. General health status was measured weekly using the EuroQol-5D. RESULTS Aspects of communication self-esteem that significantly improved with the return of voice were ability to be understood by others (P = .006) and cheerfulness (P = .04), both with a median difference from before to after return of voice of 1 on the 5-point scale. Return of voice was not associated with a significant improvement in confidence, sense of outgoingness, anger, sense of being trapped, optimism, or frustration. Reported general health status did not significantly improve. CONCLUSIONS Return of voice was associated with significant improvement in patient reported self-esteem, particularly in being understood by others and in cheerfulness. Improved self-esteem may also improve quality of life; however, further research is needed to confirm this relationship. Early restoration of voice should be investigated as a way to improve the experience of ICU for tracheostomy patients.
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Affiliation(s)
- Amy L Freeman-Sanderson
- Speech Pathology Department, Royal Prince Alfred Hospital, Camperdown, Australia; Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
| | - Leanne Togher
- Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Mark R Elkins
- Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Education & Workforce Development, Sydney Local Health District, Sydney, Australia
| | - Paul R Phipps
- Department of Intensive Care Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
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