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

    Author(s)
    Pryor, LN
    Ward, EC
    Cornwell, PL
    O'Connor, SN
    Chapman, MJ
    Griffith University Author(s)
    Cornwell, Petrea
    Year published
    2016
    Metadata
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    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 ...
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    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.
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    Journal Title
    Speech, Language and Hearing
    Volume
    19
    Issue
    4
    DOI
    https://doi.org/10.1080/2050571X.2016.1196035
    Subject
    Cognitive and computational psychology
    Cognition
    Linguistics
    Publication URI
    http://hdl.handle.net/10072/143019
    Collection
    • Journal articles

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