Above Cuff Vocalisation (ACV): A Scoping Review
Acta Anaesthesiologica Scandinavica
Petosic, A., Viravong, M. F., et al. (2021).
Acta Anaesthesiologica Scandinavica, 65(1), 15-25.
<div>This scoping review investigates the safety and effects of above-the-cuff vocalization (ACV) on communication in adults, greater than 14 years old, who are on a ventilator or have a tracheostomy.</div>
Department of Postoperative and Intensive Care, Oslo University Hospital (Norway)
From database inception to May 5, 2020
<div> Primary clinical studies (Not further specified)</div>
17
<div>Most patients (88%) produced an audible voice or whisper using ACV. For patients unable to speak with ACV, reasons included injury from inhalation/burn trauma, severe flaccid dysarthria, tracheal air leak, vocal cord paralysis, excessive secretions, granulation tissue between the vocal cords, and unspecified laryngeal pathology.</div>
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<div>Minor complications (e.g., discomfort, excessive secretions, cuff breakage, air leak, subglottic air-trapping, nausea, fatigue) occurred in 27% of ACV patients. Two patients experienced adverse events (i.e., subcutaneous emphysema due to malpositioned tracheostomy and tracheal distention due to incorrect cuff line connection).</div>
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<div>Limitations of this review include a high risk of bias, moderate-to-low quality evidence, older studies, and the possible exclusion of relevant studies. Additional research is needed to investigate the effects of ACV on communication and early laryngeal rehabilitation.</div>
<div>One study found that the ACV intervention group reported no significant difference in quality of life (QoL) when compared to the control group. Another study identified statistically significant patient-reported QoL improvements before and after ACV.</div>
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<div>Limitations of this review include a high risk of bias, moderate-to-low quality evidence, older studies, and the possible exclusion of relevant studies. Additional research is needed to investigate the effects of ACV on communication and early laryngeal rehabilitation.</div>
