How to benefit from the positive effects of Above Cuff Vocalization (ACV)

Speechless in the intensive care unit

Intensive care medicine enables critically ill people to survive accidents and illnesses. More than 90% of patients in a surgical intensive care unit are mechanically supported in their lung function [1]. A blocked tracheostomy tube ensures secure ventilation and supports the secretion management.

When awake, people typically spend 61% of their time communicating verbally with others [2] - language is thus a very central aspect of human interaction and a fundamental need.

This is usually not possible in patients with a blocked tracheostomy tube, whose cuff cannot be deflated , especially under ventilation. Asked about the stresses during the ventilation period, 58% of respondents in one study [3] said that the inability to speak had been the worst. This can lead to great frustration, aggression and even depression. Cooperation and motivation for therapy can suffer as a result.

The patient and his/her social environment

The situation is perceived as crisis-like and disturbing. Speechlessness prevails on both sides, the patient cannot speak, the relatives are unsettled. What happens when partners have to say goodbye to each other? How does the patient express his will, his wishes? Communication by writing or lip-reading is laborious and the intimacy of the encounter would be disturbed by nursing staff.

Experience language again

Above the blocked cuff, in the subglottic space (jamming corner), secretion collects that cannot be removed by normal suction through the tracheostomy tube . This secretion is potentially contaminated and can lead to infections. By using tracheostomy tubes with subglottic suction (such as the TRACOE extract tracheostomy tubes), this secretion can be suctioned out, reducing infections such as ventilator-associated pneumonia (VAP). [4]

The subglottic suction tube does not only have to be used for suction. Air can also be introduced into the TRACOE extract tracheostomy tubes through the suction tube above the blocked cuff, possibly enabling the patient to speak again = ACV.

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-> What exactly is ACV?

The use of ACV enables the patient to regain phonation with the help of the airflow. This starts in small steps up to speaking. By being able to communicate again, the patient relaxes and any aggression is reduced. Possible frustration on the part of the patient and the nursing staff is counteracted, and motivation and cooperation are increased. [5] Even if it does not work for every patient, it is definitely worth a try.

Reorientation and acceptance of the situation increases the patient's autonomy and self-care, to this end verbal communication is like a golden key. In this way, the patient's resilience can be significantly strengthened and recovery promoted. As a result, the patient is motivated and can communicate again. In these situations, the use of the ACV method is beneficial and autonomy-giving.

A subglottic flow can do much more

Further positive effects of the laryngeal flow are the sensitisation of the oropharyngeal area. This can positively influence the swallowing reflex, sensory system and the secretion management . The initiation of protective mechanisms, e.g. spontaneous swallowing reflex triggering, leads to clearing efforts and swallowing activities of the patient to control the supraglottic space. Even passive or comatose patients may benefit. [6] Therefore, an ACV attempt should be started in any case.

Further information:

TRACOE ACV Instructions for use

Above Cuff Vocalisation Brochure

Patient information

Step by step guide

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