<p></p><p>Studies have shown that patients receiving mechanical ventilation in an intensive care unit (ICU), who are entirely dependent on the nursing staff, often experience frustration due to a temporary loss of the voice source. Limited communication is an important factor contributing to patient discomfort. Nursing staff also report communication as frustrating and difficult.</p><p>The aim of the present study is to introduce a neck-type electrolarynx as a communication aid in an ICU, to study the nursing staff experiences of communication with tracheotomized patients receiving mechanical ventilation, and to examine the patient´s experiences regarding communicative abilities. Communication between a ventilator treated, tracheotomized patient and members of the nursing staff was recorded and analyzed according to principles of Conversation Analysis (CA).</p><p>The results show that several members of the nursing staff experience difficulties communicating with tracheotomized patients receiving mechanical ventilation. A majority believe that the conditions for communication could be improved. The results of CA also indicate that an electrolarynx may be an effective and appropriate communication aid for ventilator treated, tracheostomized patients. Further research is needed to broaden the knowledge of<strong> </strong>the electrolarynx as a communication aid for these patients.</p><p>Keywords: communication, mechanical ventilation, electrolarynx, patient experience, nursing staff experience, Conversation Analysis (CA).</p>

 Studies have shown that patients receiving mechanical ventilation in an intensive care unit (ICU), who are entirely dependent on the nursing staff, often experience frustration due to a temporary loss of the voice source. Limited communication is an important factor contributing to patient discomfort. Nursing staff also report communication as frustrating and difficult. The aim of the present study is to introduce a neck-type electrolarynx as a communication aid in an ICU, to study the nursing staff experiences of communication with tracheotomized patients receiving mechanical ventilation, and to examine the patient´s experiences regarding communicative abilities. Communication between a ventilator treated, tracheotomized patient and members of the nursing staff was recorded and analyzed according to principles of Conversation Analysis (CA). The results show that several members of the nursing staff experience difficulties communicating with tracheotomized patients receiving mechanical ventilation. A majority believe that the conditions for communication could be improved. The results of CA also indicate that an electrolarynx may be an effective and appropriate communication aid for ventilator treated, tracheostomized patients. Further research is needed to broaden the knowledge of the electrolarynx as a communication aid for these patients. Keywords: communication, mechanical ventilation, electrolarynx, patient experience, nursing staff experience, Conversation Analysis (CA).

Bakgrund Medicinska gaser är kalla och torra, därav behövs de befuktas och värmas för att inte åsamka skador på lungorna hos patienter som behandlas i respirator. De vanligaste metoderna är aktiv och passiv befuktning, så kallad heated humidification (HH) och heat and moisture exchanger (HME filter). Syfte Att sammanfatta befintlig forskning om för- och nackdelar samt skillnader som framkommit med aktiv respektive passiv befuktning i respirationsvård på intensivvårdsavdelning. Metod En systematiskt genomförd litteraturstudie med narrativ summering. Sökningar gjordes i databaserna CINAHL, PubMed samt Cochrane. Nio vetenskapliga artiklar med kvantitativ ansats mellan tidsintervallet 2012–2022 inkluderades utifrån PICO. Kvalitetsgranskning utfördes med validerade granskningsmallar från Joanna Briggs Institute. Huvudresultat HH tillförde mindre mekaniskt dead space för intuberade som gav bättre PaCO2 värden, vilket är specifikt fördelaktigt för patienter med acidos. Den metoden är dock mer kostsam och fungerar ej lika effektivt vid stigande rumstemperatur och direkt solljus på apparaturen. Den kräver därav mer kontroller samt tillsyn vid dessa förhållanden. Vid non-invasiv behandling och tracheostomi i respirator ger HME filter inte sämre PaCO2 värden eftersom det större mekaniska dead space den tillför inte har samma negativa effekt vid dessa behandlingar och tillstånd. Den inkrementella kostnaden är bättre för HME filter, men huruvida den ger upphov till fler incidenser av tubocklusion är ej klarlagt. Slutsats Båda befuktningsmetoderna har klara fördelar och nackdelar, därav är det fördelaktigt att ha tillgång till båda metoderna på intensivvårdsavdelningar tillsammans med en tydlig rutin om när metoderna skall användas till patienten. / Background Medical gases are cold and dry, therefore the need for adding humid and heat is highly important, otherwise they can cause damage at the lungs in patients undergoing mechanical ventilation. The most common methods are active and passive humidification so called heated humidification (HH) and heat and moisture exchanger (HME). Aim Summarize existing research on advantages, drawbacks and differences that have emerged with active and passive humidification in respiratory care in the intensive care unit. Method A systematic conducted literature review with a narrative summary to compile the results. Searches were made on the databases CINAHL, PubMed and Cochrane. Nine scientific articles with a quantitative approach between 2012-2022 were included based on PICO. Quality review was performed with validated review templates from Joanna Briggs Institute. Results HH provided less mechanical dead space for intubated patients which provided better PaCO2 values, specifically beneficial for patients with acidosis. However, this method is more expensive and does not work as effectively with increasing room temperature and direct sunlight on the equipment. It therefore requires more controls and supervision in presence of these conditions. In patients undergoing non-invasive mechanical ventilation and in patients with tracheostomy who are mechanically ventilated, HME filters do not give higher PaCO2 values. ​​The increased mechanical dead space it adds does not have the same negative effect in these treatments and conditions. The incremental cost is better for HME filters, but whether it gives rise to more incidences of tube occlusion is not clear. Conclusion Both humidification methods have clear advantages and drawbacks, hence it is advantageous to have access to both methods at intensive care units together with a clear routine about when the methods should be used.