title: Communicating with conscious and mechanically ventilated critically ill patients: a systematic review.
abstract: BACKGROUND
  Ventilator-dependent patients in the ICU often experience difficulties with one of the most basic human functions, namely communication, due to intubation. Although various assistive communication tools exist, these are infrequently used in ICU patients. We summarized the current evidence on communication methods with mechanically ventilated patients in the ICU. Secondly, we developed an algorithm for communication with these patients based on current evidence.
  
  
  METHODS
  We performed a systematic review. PubMed, Embase, Cochrane, Cinahl, PsychInfo, and Web of Science databases were systematically searched to November 2015. Studies that reported a communication intervention with conscious nonverbal mechanically ventilated patients in the ICU aged 18 years or older were included. The methodological quality was assessed using the Quality Assessment Tool.
  
  
  RESULTS
  The search yielded 9883 publications, of which 31 articles, representing 29 different studies, fulfilled the inclusion criteria. The overall methodological quality varied from poor to moderate. We identified four communication intervention types: (1) communication boards were studied in three studies-they improved communication and increased patient satisfaction, but they can be time-consuming and limit the ability to produce novel utterances; (2) two types of specialized talking tracheostomy tubes were assessed in eight studies-audible voicing was achieved in the majority of patients (range 74-100 %), but more studies are needed to facilitate safe and effective use; (3) an electrolarynx improved communication in seven studies-its effectiveness was mainly demonstrated with tracheostomized patients; and (4) "high-tech" augmentative and alternative communication (AAC) devices in nine studies with diverse computerized AAC devices proved to be beneficial communication methods-two studies investigated multiple AAC interventions, and different control devices (e.g., touch-sensitive or eye/blink detection) can be used to ensure that physical limitations do not prevent use of the devices. We developed an algorithm for the assessment and selection of a communication intervention with nonverbal and conscious mechanically intubated patients in the ICU.
  
  
  CONCLUSIONS
  Although evidence is limited, results suggest that most communication methods may be effective in improving patient-healthcare professional communication with mechanically ventilated patients. A combination of methods is advised. We developed an algorithm to standardize the approach for selection of communication techniques.
authors.affiliation: Department of Intensive Care Medicine and Research VUmc Intensive Care (REVIVE), VU University Medical Center Amsterdam, Room ZH-7D-166, De Boelelaan 1117, PO Box 7057, Amsterdam, 1007 MB, The Netherlands.|Institute for Cardiovascular Research VU (ICaR-VU), VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Ten Hoorn
authors.affiliation: Department of Intensive Care Medicine and Research VUmc Intensive Care (REVIVE), VU University Medical Center Amsterdam, Room ZH-7D-166, De Boelelaan 1117, PO Box 7057, Amsterdam, 1007 MB, The Netherlands.|Institute for Cardiovascular Research VU (ICaR-VU), VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: P W
authors.initials: PW
authors.lastname: Elbers
authors.affiliation: Department of Intensive Care Medicine and Research VUmc Intensive Care (REVIVE), VU University Medical Center Amsterdam, Room ZH-7D-166, De Boelelaan 1117, PO Box 7057, Amsterdam, 1007 MB, The Netherlands.|Institute for Cardiovascular Research VU (ICaR-VU), VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: A R
authors.initials: AR
authors.lastname: Girbes
authors.affiliation: Department of Intensive Care Medicine and Research VUmc Intensive Care (REVIVE), VU University Medical Center Amsterdam, Room ZH-7D-166, De Boelelaan 1117, PO Box 7057, Amsterdam, 1007 MB, The Netherlands. p.tuinman@vumc.nl.|Institute for Cardiovascular Research VU (ICaR-VU), VU University Medical Center Amsterdam, Amsterdam, The Netherlands. p.tuinman@vumc.nl.
authors.forename: P R
authors.initials: PR
authors.lastname: Tuinman
mesh_terms: D003142:Communication; D003243:Consciousness / Q000187:drug effects; D016638:Critical Illness / Q000523:psychology*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D012121:Respiration, Artificial / Q000009:adverse effects*
keywords: Communication intervention; Communication methods; Communication tools; Intensive care; Mechanical ventilation