Implementation of Above-Cuff Vocalization After Tracheostomy Is Feasible and Associated With Earlier Speech.

PURPOSE: The purpose of this study was to assess the feasibility of hospital-wide implementation of an above-cuff vocalization (ACV) protocol using ACV-capable tracheostomy tubes and its impact on patient speech in four intensive care unit (ICU) patient populations. METHOD: This research was an observational pre-post study that was conducted over a 26-month period and included 323 critically ill adult ICU patients who underwent tracheostomy in a 365-bed academic tertiary care hospital. ACV was assessed using a protocol developed by a multidisciplinary team. Presence of speech was defined as at least one comprehensible word spoken during a speech-language pathologist evaluation. RESULTS: Median time-to-speech was 13 days (interquartile range [IQR]: 8-20 days) before the intervention, compared to 9 days (IQR: 6-16 days) after the intervention (p = .0017). In the pre-intervention group, 101 out of 167 (60.5%) patients achieved speech within 60 days, compared to 83 out of 133 (62.4%) patients in the post-intervention group (p = .12). Of the 83 patients who achieved speech in the post-intervention group, 24 (28.9%) did so via ACV, with the remainder using a speaking valve or digital occlusion. Of those 24 patients, seven did not progress to using a speaking valve within the follow-up period. The median number of speech days gained by using ACV was 8 (IQR: 5-18 days). ACV was successful in facilitating speech in 24 out of 29 (82.8%) patients trialed, with no major complications. CONCLUSIONS: Routine implementation of ACV after tracheostomy is feasible, safe, and associated with earlier speech in a diverse population of critically ill patients. ACV is an important method to facilitate communication in patients requiring mechanical ventilation with tracheostomy cuff inflation.

Genetics of Malignant Hyperthermia: A Brief Update.

Malignant hyperthermia susceptibility (MHS) and the associated condition malignant hyperthermia (MH) are rare but well-known disorders in the field of anesthesiology. MHS is usually determined by a history of a family member developing a positive episode during general anesthesia and then confirmed by an invasive caffeine halothane contracture test (CHCT). More recently, within the context of MH as a pharmacogenetic disorder, the question of whether or not MHS can be principally genetically determined is of high importance as knowledge of detailed pathogenesis may prevent against its largely invariable lethality if untreated. Thus, in this brief report, genetic terms, as well as updates in the genetics of MHS, will be reviewed in order to better understand both the condition and the current research.