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

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 (R) tracheostomy tube system (Blom (R) 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 (R) 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 (R) speech cannula in situ. One patient was sensitive to respiratory changes imposed by the three different inner cannulas of the Blom (R) 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 (R) TTS depending on the degree of respiratory impairment and prognosis for weaning following CSCI.