Giving a voice to critically ill patients - literally

The Intensive Care Unit, or ICU, can be a pretty scary place for patients. For tracheostomy patients this is compounded by not being able to speak or communicate effectively. Around 15,000 tracheostomies are performed in England each year, with about two-thirds of these inserted into the critically ill.

The commonest reason for a tracheostomy in the ICU is to allow continued artificial ventilation whilst a patient’s lungs recover from illness. The way that gas is delivered via the tracheostomy tube into the lungs means that no gas flows through the voice box and upper airways, so the patients can’t speak at all.

At University Hospital South Manchester we wanted to make things better for these patients. My colleague James (an ICU charge nurse) and I had heard about new ways of introducing a bit of airflow that is directed out through the voice box and mouth using a special type of tracheostomy tube, allowing tracheostomy patients to communicate.

Through the Global Tracheostomy Collaborative, we got to know colleagues from the TRAMS team working in Melbourne, Australia. They showed us what they were doing and we were amazed to see first-hand that patients who we would never have considered could potentially talk were communicating clearly with staff and relatives whilst still fully dependant on the ventilator. It also turned out that the ‘special’ type of tube they were using was one that we use routinely anyway, but we just needed to use it in a different, innovative way. And with funding from the Health Foundation’s Shine programme, we were able to start working on a project to deliver quality improvements in tracheostomy care.

We tried it straight away in two of our patients who gave us permission to show them in the video. Both of these patients had been awake but unable to talk for a number of days. You can see and hear in the video below how they get a voice, and how pleased they were. It’s amazing to see a relatively simple intervention like this, learned from colleagues on the other side of the world, have such a dramatic impact on our patients.

We would stress that this is a technique to be used under extremely close supervision by qualified staff, and it is one that we are studying in detail at the moment. Our Health Foundation project has really opened up the opportunity for us to learn and share from colleagues around the world as we aim to improve care everywhere. The power of collaboration!

Brendan is a Consultant in Anaesthesia & Intensive Care Medicine at University Hospital of South Manchester NHS Foundation Trust.