Dr Louise Rose and colleagues recently published their review titled "Interventions to enable communication for adult patients requiring an artificial airway with or without mechanical ventilator support". You can read the Plain Language Summary below or access the full review on the Cochrane Library.
What is the issue?
Patients needing a machine to support breathing cannot speak due to a tube delivering gas to the lungs bypassing their voice box. Patients mouth words, gesture, and use facial expressions. However, these are very difficult to understand. Weakened muscles and difficulty concentrating, which are common in critical illness, makes using aids such as writing equipment or communication boards difficult. Consistent evidence on which communication aids are effective is lacking.
Why is this important?
Difficulty communicating places people at increased risk of harm, causes distress to patients and family, and causes stress for healthcare staff.
What evidence did we find?
We searched for studies (to 30 July 2020) exploring aids used to help people with a breathing tube to communicate. We found 11 studies involving 1931 participants admitted to intensive care units. We also looked for studies involving people needing a breathing tube and living at home or in long‐term care, but found none. Eight studies used communication boards or apps. Three studies used aids that help a patient to speak with the breathing tube in place. All studies compared the communication aid to routine communication practices. For six studies, routine practice did not include use of any type of communication aid. For the remaining five studies, usual care comprised a range of communication aids routinely used in the participating intensive care units including a communication board, paper notepad, and routine timing of the use of speech aids. We are unsure about whether the early use of aids to help with speaking may increase the number of people who can say words that can be understood or shorten the time to be able to speak. The evidence was of very low quality.
Similarly, compared to routine care in which an aid is not used, we are uncertain about the effects of communication boards on patient satisfaction. We are not sure about the effect on psychological distress and quality of life due to uncertainty in the evidence. Communication aids that help people to speak may have little or no effect on intensive care unit length of stay (low‐quality evidence). We are uncertain of possible harms with use of communication aids as only three studies reported this, and all measured different adverse events, and two were very small studies.
What does this mean?
We are unsure whether using speaking aids in intensive care might increase the number of people who can say words that can be understood. Use of communication boards may increase patient satisfaction, but we are not sure of these findings because of very low‐quality evidence. This means further studies are likely to change our understanding of the effects of communication aids. More studies are needed to understand the effects of communication aids, particularly effects on psychological well‐being and people's ability to communicate.