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Rose L, Watling L, Kohli R, Bautista C, Renzetti D, Avendano M, Goldstein R. Transition program for ventilator assisted individuals from acute care to home. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2019. [DOI: 10.1080/24745332.2018.1514674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Louise Rose
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, London, United Kingdom
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Michael Garron Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Laura Watling
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Raj Kohli
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | | | | | - Monica Avendano
- West Park Healthcare Centre, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Roger Goldstein
- West Park Healthcare Centre, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- NSA Chair in Respiratory Rehabilitation Research, Toronto, Ontario, Canada
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Hartley NA. Spinal cord injury (SCI) rehabilitation: systematic analysis of communication from the biopsychosocial perspective. Disabil Rehabil 2015; 37:2383-2392. [DOI: 10.3109/09638288.2015.1027008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Garguilo M, Leroux K, Lejaille M, Pascal S, Orlikowski D, Lofaso F, Prigent H. Patient-controlled positive end-expiratory pressure with neuromuscular disease: effect on speech in patients with tracheostomy and mechanical ventilation support. Chest 2013; 143:1243-1251. [PMID: 23715608 DOI: 10.1378/chest.12-0574] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Communication is a major issue for patients with tracheostomy who are supported by mechanical ventilation. The use of positive end-expiratory pressure (PEEP) may restore speech during expiration; however, the optimal PEEP level for speech may vary individually. We aimed to improve speech quality with an individually adjusted PEEP level delivered under the patient's control to ensure optimal respiratory comfort. METHODS Optimal PEEP level (PEEPeff), defined as the PEEP level that allows complete expiration through the upper airways, was determined for 12 patients with neuromuscular disease who are supported by mechanical ventilation. Speech and respiratory parameters were studied without PEEP, with PEEPeff, and for an intermediate PEEP level. Flow and airway pressure were measured. Microphone speech recordings were subjected to both quantitative and qualitative assessments of speech, including an intelligibility score, a perceptual score, and an evaluation of prosody determined by two speech therapists blinded to PEEP condition. RESULTS Text reading time, phonation flow, use of the respiratory cycle for phonation, and speech comfort significantly improved with increasing PEEP, whereas qualitative parameters remained unchanged. This resulted mostly from the increase of the expiratory volume through the upper airways available for speech for all patients combined, with a rise in respiratory rate for nine patients. Respiratory comfort remained stable despite high levels of PEEPeff (median, 10.0 cm H2O; interquartile range, 9.5-12.0 cm H₂O). CONCLUSIONS Patient-controlled PEEP allowed for the use of high levels of PEEP with good respiratory tolerance and significant improvement in speech (enabling phonation during the entire respiratory cycle in most patients). The device studied could be implemented in home ventilators to improve speech and, therefore, autonomy of patients with tracheostomy. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01479959; URL: clinicaltrials.gov.
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Affiliation(s)
- Marine Garguilo
- EA4497 of the University of Versailles Saint-Quentin-en-Yvelines, Versailles, Garches
| | - Karl Leroux
- Association d'Entraide des Polios et Handicapés (ADEP Assistance), Suresnes, Garches
| | - Michèle Lejaille
- EA4497 of the University of Versailles Saint-Quentin-en-Yvelines, Versailles, Garches; Centre d'Investigation Clinique Innovations Technologiques, Garches
| | - Sophie Pascal
- Service de Médecine Physique et Réadaptation, Garches
| | - David Orlikowski
- EA4497 of the University of Versailles Saint-Quentin-en-Yvelines, Versailles, Garches; Centre d'Investigation Clinique Innovations Technologiques, Garches; Home Ventilation Unit (Intensive Care Department), Garches
| | - Frédéric Lofaso
- EA4497 of the University of Versailles Saint-Quentin-en-Yvelines, Versailles, Garches; Physiology Department, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches; INSERM U492, Créteil, France
| | - Hélène Prigent
- EA4497 of the University of Versailles Saint-Quentin-en-Yvelines, Versailles, Garches; Physiology Department, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris, Garches.
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Laakso K, Markström A, Havstam C, Idvall M, Hartelius L. Communicating with individuals receiving home mechanical ventilation: the experiences of key communication partners. Disabil Rehabil 2013; 36:875-83. [PMID: 23930644 DOI: 10.3109/09638288.2013.822572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of the study was to explore the communication experiences of key communications partners (CPs) of individuals receiving home mechanical ventilation (HMV), with particular emphasis on the possibilities, difficulties and limitations CPs experienced in communication, possible support given to facilitate communication and exploring what made a skilled communicator. METHOD A qualitative research design using interviews was used. The participants included 19 key CPs of individuals receiving HMV. RESULTS The analysis resulted in five themes: Encountering communication limitations, Functional communication strategies, Being a communication facilitator, Role insecurity and Emotional reactions and coping. The findings revealed that CPs needed to develop partly new reference frames for communication. In particular, participants emphasised the need to understand and interpret subtle details in the communicative interaction. CONCLUSIONS The findings are discussed in the light of previous research, in particular an earlier study exploring another perspective; the ventilator-supported individuals' experiences of communication. Issues relating to the educational needs of CPs of individuals receiving HMV are discussed. The results are intended to enhance understanding of the challenges that individuals receiving HMV and their CPs face with communication, which should be of relevance not only to speech therapists, but for all healthcare practitioners in the field of HMV.
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Affiliation(s)
- Katja Laakso
- Institute of Neuroscience and Physiology, Division of Speech and Language Pathology, University of Gothenburg , Gothenburg , Sweden
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Laakso K, Markström A, Idvall M, Havstam C, Hartelius L. Communication experience of individuals treated with home mechanical ventilation. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2011; 46:686-699. [PMID: 22026570 DOI: 10.1111/j.1460-6984.2011.00040.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Mechanical ventilatory support seriously affects speaking and communication, and earlier studies show that many ventilator-supported patients experience difficulties and frustration with their speech and voice production. Since there is a growing number of individuals who require mechanical ventilatory support and there is a paucity of studies that examine ventilator-supported communication, this research area needs to be developed to ensure adequate health services for this population. The present study focused on ventilator-supported communication from the point of view of individuals receiving home mechanical ventilation (HMV). AIMS The specific aim was to examine the communication experience of individuals receiving HMV. METHODS & PROCEDURES A qualitative approach was adopted for this study, and data were collected by means of semi-structured interviews. Qualitative content analysis was used to structure, condense and interpret the data. The participants were recruited from the National Respiratory Centre (NRC) in Sweden, and included 19 individuals receiving HMV. OUTCOMES & RESULTS The main theme A long and lonely struggle to find a voice and six subthemes detailing different facets of it emerged from data analysis: Managing changed speech conditions, Prioritising voice, A third party supporting communication, Using communication to get things done, Depending on technology, and Facing ignorance. Important aspects influencing the ventilator-supported individuals' communicative performance (speech, support from others and technological solutions) are discussed. CONCLUSIONS & IMPLICATIONS The study revealed that healthcare practitioners involved in the care of individuals receiving HMV need to improve their understanding and knowledge of issues related to ventilator-supported communication. Individuals receiving HMV encounter a needlessly long and lonely struggle to achieve effective communication. They face numerous challenges regarding their communication, and they need to be heard in both literal and figurative senses. To overcome these challenges they need support from competent healthcare practitioners and personal assistants, and continuous follow-up by speech and language therapists tailoring communicative solutions to fit individual needs.
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Affiliation(s)
- Katja Laakso
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Stockholm, SwedenLund University, The Swedish Institute for Health Sciences (Vårdal Institute), Lund, Sweden
| | - Agneta Markström
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Stockholm, SwedenLund University, The Swedish Institute for Health Sciences (Vårdal Institute), Lund, Sweden
| | - Markus Idvall
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Stockholm, SwedenLund University, The Swedish Institute for Health Sciences (Vårdal Institute), Lund, Sweden
| | - Christina Havstam
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Stockholm, SwedenLund University, The Swedish Institute for Health Sciences (Vårdal Institute), Lund, Sweden
| | - Lena Hartelius
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, SwedenKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, National Respiratory Centre, Stockholm, SwedenLund University, The Swedish Institute for Health Sciences (Vårdal Institute), Lund, Sweden
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