A Multidisciplinary Approach to Verbal Communication Interventions for Mechanically Ventilated Adults With a Tracheostomy

There is developing evidence with regard to the feasibility, utility, and safety of verbal communica-tion interventions with patients with tracheostomy who are invasively ventilated. In the past 2 deca-des, research efforts have focused on establishing evidence for communication interventions, including introducing an intentional leak into the ventilatory circuit such as with a fenestrated tube, leak speech or ventilator-adjusted leak speech, the use of a one-way valve in-line with the ventilator, and above cuff vocalization. This narrative review describes the benefits of a multi-disciplinary approach, summarizes verbal communication interventions, and provides guidance on the indica-tions, contraindications and considerations for patient selection. Our clinical procedures based on collective clinical experience are shared. A multidisciplinary team approach enables holistic manage-ment across acuity, ventilation, airway, communication, and swallowing parameters. This collabora-tive approach is recommended to maximize the chance of successful opportunities for patients to communicate safely and effectively.