Feasibility of the electrolarynx for enabling communication in the chronically critically ill: The EECCHO study

Feasibility of the electrolarynx for enabling communication in the chronically critically ill: The EECCHO study

To assess feasibility of producing intelligible and comprehensible speech with an electrolarynx; measure anxiety, communication ease, and satisfaction before/after electrolarynx training; and identify barriers/facilitators. We included tracheostomized adults from 3 units following commands, reading...

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Bibliographic Details
Published in:Journal of critical care Vol. 47; pp. 109 - 113
Main Authors: Rose, Louise, Istanboulian, Laura, Smith, Orla M., Silencieux, Soledad, Cuthbertson, Brian H., Amaral, Andre Carlos Kajdacsy-Balla, Fraser, Ian, Grey, Joanne, Dale, Craig
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-10-2018
Elsevier Limited
Subjects:
Alternative augmented communication
Anxiety
Communication
Communication tools
Critical care
Data collection
Deflation
Electrolarynx
Feasibility studies
Intensive care
Larynx
Ostomy
Patients
Speaking
Speech
Tracheostomy
Ventilators
Weaning
Speech
Tracheostomy
Intensive care
Alternative augmented communication
Electrolarynx
Communication tools
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Summary:To assess feasibility of producing intelligible and comprehensible speech with an electrolarynx; measure anxiety, communication ease, and satisfaction before/after electrolarynx training; and identify barriers/facilitators. We included tracheostomized adults from 3 units following commands, reading English, and mouthing words. On enrolment, we measured anxiety, ease, and satisfaction with communication. We gave electrolarynx instruction for ≤5 days then 2 independent raters assessed intelligibility, sentence comprehensibility (9-point difficulty scale), and Electrolarynx Effectiveness Score (EES), and re-evaluated anxiety, communication ease, and satisfaction. Interviews explored barriers/facilitators. We recruited 24 participants (Jan2015-Dec2016). Mean (SD) intelligibility was 45%(18%) words correct: 57%(21%) when facing. Mean comprehension difficulty was 6.4(2.0) overall, indicating moderate difficulty (5.5(2.5) scored visualizing). Mean EES was 2.9(1.0) (3 = improved lip-reading through recognizable sounds). Anxiety decreased from median 3.8 to 2.0 (P = .007). Communication was rated easier (median 15 vs 12, P = .04) whereas satisfaction remained similar (P = .06). Facilitators included device friendliness, patient independence, and word intelligibility. Barriers were patient weakness, difficulty positioning the device, and limited sentence as opposed to word intelligibility. The electrolarynx may aid intelligible speech for some tracheostomized patients if the communication partner can visualize the users face, and reduce anxiety and make patient perceived communication easier. •The electrolarynx may aid intelligible speech if the communication partner can visualize the face.•The electrolarynx reduced anxiety and made patient perceived communication easier.•Facilitators to use included device friendliness, patient independence, and word intelligibility.•Barriers were patient weakness, difficulty positioning the device, and limited sentence as opposed to word intelligibility.
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ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2018.06.013