| Patient frustrations are paramount. An inability to communicate, due to the failure of air to pass through the vocal cords, results in chronic frustration. At a time in the patient’s life where he or she is undergoing dramatic changes, there is often a feeling of isolation due to the inability to freely communicate.
Techniques that allow the patient to communicate include writing, use of a Passy-Muir valve if tolerated, and deflation of the tracheostomy cuff to allow more air to move through the vocal cord. Patients on mechanical ventilation can produce sounds during the expiratory cycle, which disrupts the flow of conversation. Sometimes, valves do not allow adequate air to pass around the tracheostomy. A fenestrated tracheostomy tube has holes that allow air to pass through the vocal cords. A speaking valve redirects air by directing it through the trach tube when the patient inspires, while closing the tube on expiration in order to direct the expired air through the glottis and the upper airway. Many patients who are at risk for aspiration, or have copious secretions, medical instability or inability to tolerate deflation of the cuff will not benefit from these techniques. | | | | |
