Preserving Oral Communication in Individuals With Tracheostomy and Ventilator Dependency How to preserve oral communication in patients with tracheostomy is the primary focus of this paper. We review the approaches applicable to patients who breathe independently and to patients who depend on coupling to a ventilator. For the former, valving the tracheostomy cannula to provide inspiration through the cannula and ... Clinical Focus
Clinical Focus  |   May 01, 1995
Preserving Oral Communication in Individuals With Tracheostomy and Ventilator Dependency
 
Author Affiliations & Notes
  • Donna C. Tippett
    Good Samaritan Hospital, Baltimore Johns Hopkins University, Baltimore
  • Arthur A. Siebens
    Good Samaritan Hospital, Baltimore Johns Hopkins University, Baltimore
  • Contact author: Donna C. Tippett, MA, Department of Communication Sciences and Disorders, Shock Trauma Center, University of Maryland Medical System, 22 S. Greene Street, Baltimore, MD 21201-1595
Article Information
Swallowing, Dysphagia & Feeding Disorders / Speech, Voice & Prosody / Clinical Focus
Clinical Focus   |   May 01, 1995
Preserving Oral Communication in Individuals With Tracheostomy and Ventilator Dependency
American Journal of Speech-Language Pathology, May 1995, Vol. 4, 55-61. doi:10.1044/1058-0360.0402.55
History: Received March 28, 1994 , Accepted October 25, 1994
 
American Journal of Speech-Language Pathology, May 1995, Vol. 4, 55-61. doi:10.1044/1058-0360.0402.55
History: Received March 28, 1994; Accepted October 25, 1994

How to preserve oral communication in patients with tracheostomy is the primary focus of this paper. We review the approaches applicable to patients who breathe independently and to patients who depend on coupling to a ventilator. For the former, valving the tracheostomy cannula to provide inspiration through the cannula and expiration through the larynx is often practical and effective. For the latter, deflating the cuff, which is often inflated to seal the cannula in the trachea, may preserve oral communication without sacrificing alveolar ventilation. Our experiences with these patient populations are reviewed together with an exposition of valving and cuff deflation. Although the literature includes references to these practices, it also suggests that their recognition is restricted. Our own experiences justify confidence in the effectiveness of these compensations for the communication impairments which result from tracheostomy with or without ventilator dependency.

Acknowledgments
The authors are indebted to Nancy Hayter and Arnold Dent of the Department of Respiratory Care, Good Samaritan Hospital, Baltimore, Maryland, for their particular interest in restoring oral communication to patients with tracheostomy and ventilator dependency. The contributions of numerous nurses and therapists in the rehabilitation medicine program and the consultation of James Heroy, Stephen Sellinger, and Howard Steiner are also acknowledged with gratitude. Joseph French was invaluable by virtue of designing the Hopkins speaking valve, and Nell Kirby in providing them. The patience and skill of Linda Zeigenfuse in preparing this manuscript was appreciated greatly.
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