Establishing phonation using the Blom® tracheostomy tube system: A report of three cases post cervical spinal cord injury

Abstract

Objective: Mechanically ventilated patients with cervical spinal cord injury (CSCI) have few options for verbal communication in the acute phase post injury. Leak speech and one-way speaking valves can restore laryngeal airflow; however, both methods require deflation of the tracheostomy cuff which is not always possible. The Blom® tracheostomy tube system (Blom® TTS) provides an option for restoring speech while maintaining cuff inflation, through insertion of a flexible tapered speech cannula into a fenestrated outer cannula. Two studies have reported on the speech achieved with this tube, yet these focused on mixed clinical groups and only examined immediate changes to communication. Longer-term use and patient perceptions of communicating with this system have not been reported.

Methods: This paper describes the introduction of the Blom® TTS into three individuals with tetraplegia following CSCI and follows their outcomes throughout their intensive care admission.

Results: The tube was successfully placed in two of the three participants. Of these two, phonation was easily established and high levels of patient-perceived comfort and ease and quality of voicing were found when speaking and breathing with the Blom® speech cannula in situ. One patient was sensitive to respiratory changes imposed by the three different inner cannulas of the Blom® TTS and did not complete weaning with the speech cannula in situ.

Conclusions: The current research adds support for early restoration of speech via a cuffed tracheostomy during mechanical ventilation in the intensive care unit. Long-term use however identified some potential issues with patient tolerance and safety of the different inner cannulas which may need to be considered for longer-term clinical management. The cases highlight differences in use of the Blom® TTS depending on the degree of respiratory impairment and prognosis for weaning following CSCI.