Chest
Clinical Investigations in Critical CareClinical Ventilator Adjustments That Improve Speech
Section snippets
Materials and Methods
We studied 15 subjects with spinal cord injuries or neuromuscular diseases (Table 1 ), who lived in extended-care facilities or at home. Thirteen subjects received ventilation with volume-controlled positive pressure and produced speech with the tracheostomy tube cuff deflated or with a cuffless tracheostomy tube (either fenestrated or unfenestrated). All but one subject (subject 2) routinely maintained a deflated cuff throughout the waking hours. Four subjects (subjects 2, 5, 7, and 13)
Results
Speech improved in 12 of our 15 subjects with one or more of the interventions. Results of successful interventions are presented below according to type. Unsuccessful cases are considered separately thereafter.
Discussion
These interventions improved speech, especially when used in combination. Also, the application of high PEEP was found to be as effective as a one-way valve.
ACKNOWLEDGMENTS
We thank the medical staff at New England Sinai Hospital and Rehabilitation Center, West Roxbury Veterans Administration Medical Center, Posada del Sol Health Care Center, and John C. Lincoln Hospital, especially Dr. Lawrence Hotes, Dr. Leonard Ditmanson, and James Ruf, RRT. We also thank Marie Duggan, RRT, for her assistance in data collection; Robert Chase, RRT, for helping us use the stoma seal he developed; and those who helped with data analysis and other aspects of the study, most notably
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Drs. Banzett and Brown are currently affiliated with the Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, MA.
Support was provided by National Institute on Deafness and Other Communication Disorders grants DC-03425 and DC-01409.