title: Ventilator-assisted patient vocalization with positive end-expiratory pressure and tracheostomy cuff leak: a brief report.
abstract: OBJECTIVE
  To enable vocalization in a tracheostomized ventilator-assisted patient without compromising pulmonary status.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University-affiliated nonprofit hospital.
  
  
  METHODS
  A 62-year-old man with a medical history of metastatic lung cancer and chronic obstructive pulmonary disease received mechanical ventilation for 24 days. On the twenty-first day of ventilation the patient requested in writing the desire to vocalize with his family.
  
  
  METHODS
  Flow-generated positive end-expiratory pressure of +3 cm of water (PEEP of 3 cm H2O) was applied to the patient's airway and the tracheostomy cuff was slowly deflated to create a cuff leak. The patient was instructed to phonate the letter /a/ until the sound became audible. Lack of voice intensity necessitated PEEP titration of 1 cm H2O increments until 8 cm H2O of PEEP intensified the voice.
  
  
  CONCLUSIONS
  During each session, the patient was able to vocalize clearly, without complications, as measured by the physiologic parameters: heart rate, respiratory rate, blood pressure, and oxygen saturation determined by oximetry.
authors.affiliation: University of Medicine and Dentistry of New Jersey, Respiratory Care Program, Camden.
authors.forename: F
authors.initials: F
authors.lastname: Austan
mesh_terms: D003142:Communication; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000628:therapy; D008175:Lung Neoplasms / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010699:Phonation; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000379:methods*; D014139:Tracheostomy / Q000295:instrumentation / Q000379:methods*; D015300:Ventilator Weaning / Q000379:methods; D014831:Voice