Above Cuff Vocalisation (ACV) Safety Guidelines

Above cuff vocalisation (ACV) involves applying an external airflow through the subglottic port of a tracheostomy tube to restore laryngo-pharyngeal airflow¹. This can improve airway protection and swallowing and support vocalisation². However, clinical practice varies and safety concerns exist³. Here at Atos Medical, we have worked with a group of expert clinicians and academics to produce a clinical consensus document on a range of safety statements for ACV.

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Resources

1 Mills, C. S., Cuthbertson, B. H., & Michou, E. (2023). What’s new in reducing the impact of tracheostomy on communication and swallowing in the ICU. Intensive care medicine, 49(7), 860-863.A

2 Mills, C. S., Michou, E., King, N., Bellamy, M. C., Siddle, H. J., Brennan, C. A., & Bojke, C. (2022). Evidence for above cuff vocalization in patients with a tracheostomy: a systematic review. The Laryngoscope, 132(3), 600-611.

Pandian, V., Cole, T., Kilonsky, D., Holden, K., Feller-Kopman, D. J., Brower, R., & Mirski, M. (2020). Voice-related quality of life increases with a talking tracheostomy tube: a randomized controlled trial. The Laryngoscope, 130(5), 1249-1255.

McGrath, B. A., Wallace, S., Wilson, M., Nicholson, L., Felton, T., Bowyer, C., & Bentley, A. M. (2019). Safety and feasibility of above cuff vocalisation for ventilator-dependant patients with tracheostomies. Journal of the Intensive Care Society, 20(1), 59-65.

McGrath, B., Lynch, J., Wilson, M., Nicholson, L., & Wallace, S. (2016). Above cuff vocalisation: A novel technique for communication in the ventilator-dependent tracheostomy patient. Journal of the Intensive Care Society, 17(1), 19-26.

3 Mills, C. S., Michou, E., Bellamy, M. C., Siddle, H. J., Brennan, C. A., & Bojke, C. (2024). Worth a try or a last resort: Healthcare professionals’ experiences and opinions of above cuff vocalisation. International Journal of Language & Communication Disorders, 59(3), 932-946.

Mills, C. S., Michou, E., Bellamy, M. C., Siddle, H. J., Brennan, C. A., & Bojke, C. (2022). Determining the prevalence, implementation approaches, and opinions of above cuff vocalization: a survey of health care professionals. Archives of Physical Medicine and Rehabilitation, 103(3), 394-401.