• Vinciya Pandian, Sarah Boisen, Shifali Mathews, and Michael J Brenner.
• Vinciya Pandian is an associate professor, Johns Hopkins School of Nursing, Baltimore, Maryland. Sarah Boisen is an intensive care unit nurse, The Johns Hopkins Hospital, Baltimore, Maryland. Shifali Mathews is a BS student and research assistant, Johns Hopkins School of Nursing. Michael J. Brenner is an associate professor, Department of Otolaryngology-Head & Neck Surgery, Michigan Medicine-University of Michigan, Ann Arbor, Michigan. vpandia1@jhu.edu.
• Am. J. Crit. Care. 2019 Nov 1; 28 (6): 441-450.

ObjectiveTo synthesize evidence of the safety and effectiveness of phonation in patients with fenestrated tracheostomy tubes.MethodsPubMed, CINAHL, Scopus, Cochrane, and Web of Science databases were searched. The research question was, "Are fenestrated tracheostomy tubes a safe and effective option to facilitate early phonation in patients undergoing tracheostomy?" Studies of fenestrated tracheostomy tubes were assessed for risk of bias and quality of evidence. Data were abstracted, cross-checked for accuracy, and synthesized.ResultsOf the 160 studies identified, 13 met inclusion criteria, including 6 clinical studies (104 patients), 6 case reports (13 patients), and 1 nationwide clinician survey. The primary indications for a tracheostomy were chronic ventilator dependence (83%) and airway protection (17%). Indications for fenestrated tracheostomy included inaudible phonation and poor voice intelligibility. Patients with fenestrated tubes achieved robust voice outcomes. Complications included granulation tissue (6 patients [5%]), malpositioning (1 patient [0.9%]), decreased oxygen saturation (3 patients [2.6%]), increased blood pressure (1 patient [0.9%]), increased peak pressures (2 patients [1.7%]), and air leakage (1 patient [0.9%]); subcutaneous emphysema also occurred frequently. Patient-reported symptoms included shortness of breath (4 patients [3.4%]), anxiety (3 patients [2.6%]), and chest discomfort (1 patient [0.9%]).ConclusionsFenestrated devices afford benefits for speech and decannulation but carry risks of granulation, aberrant airflow, and acclimation challenges. Findings highlight the need for continued innovation, education, and quality improvement around the use of fenestrated devices.©2019 American Association of Critical-Care Nurses.

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