Products & Knowledge

TRACOE ACV: Audible example of a patient

Speechless in the intensive care unit

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

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


This is usually not possible for patients with a blocked tracheostomy tube whose cuff cannot be deflated, especially with ventilation. In a study [3], 58% of those questioned asked about the stress during the ventilation period, saying that the inability to speak was the worst. This can lead to great frustration, aggressiveness and even depression. This can affect cooperation and motivation of the patient for therapy.


The patient and his social environment

The situation is perceived as critical and disturbing. There is speechlessness on both sides, the patient cannot speak, the relatives are insecure. What if partners have to say goodbye to each other? How does the patient express his will, his wishes? Communication through writing down or lip reading is tedious and the intimacy of the encounter would be disturbed by nursing staff.


Experience language again

Secretions collect above the inflated cuff in the subglottic area (misery corner) that cannot be removed by normal suction through the tube. This secretion is potentially contaminated and can lead to infections. By using tracheostomy tubes with subglottic suction (like the TRACOE extract tracheostomy tubes), this secretion can be aspirated and thus infections, such as ventilator-associated pneumonia or events (VAP or VAE) can be reduced.[4]


The subglottic suction line does not only have to serve for suction. Air can also be introduced into the TRACOE extract tube through the suction line above the blocked cuff, possibly putting the patient back in a position to speak = ACV.

-> What exactly is ACV?

The application of the ACV enables the patient to phonate again using the airflow. This starts in small steps up to speaking. The possibility of being able to communicate again means that the patient relaxes and any aggressions are reduced. Possible frustration with patient and nursing staff is counteracted, and motivation and cooperation are increased. [5] Even if it doesn't work for every patient, it is definitely worth trying.


Reorientation and acceptance of the situation increases the patient's autonomy and self-care, and verbal communication is like a golden key. This significantly strengthens the patient's resilience and promotes recovery. As a result, the patient is motivated and can communicate again. In these situations, the use of the ACV method is beneficial and creates autonomy.


A subglottic flow can do much more

Other positive effects from the laryngeal flow are sensitization in the oropharyngeal area. Swallowing reflex, sensors and secretion management can be positively influenced. The initiation of protective mechanisms, e.g. spontaneous swallowing reflex triggering leads to clearing efforts and swallowing activities of the patient in order to control the supraglottic space. Even passive or comatose patients can benefit from it. [6] Therefore, an ACV attempt should definitely be started.


More information:

TRACOE ACV Instructions for Use

Above Cuff Vocalisation Brochure

Patient Information

Step-by-Step Instructions

-> Experience of a clinical speech therapist on this:N. Niers:„ Possibilities and Opportunities for Subglottic Air Insufflation in Patients with Tracheostomies, N. Niers, RespiratoryTherapy, Fall 2019“ (verlinken)
-> Publication: Above Cuff Vocalisation (ACV), M. From et al, Respiratory Therapy, Spring 2020- p33-36
-> Publication: Above CuffVocalisation-A novel technique for communication in theventilator-dependent tracheostomy patient, McGrath et al, JICS 2016Speechless in the intensive care unit

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[1] A.-K.Liedtke, Kann der beatmete Patient aktiv kommunizieren? Hallesche Beiträge zu den Gesundheits- und Pflegewissenschaften, 5. Jahrgang, Heft 1, 2006
 [2]Adler RB, Rodman G. Understanding Human Communication. New York: Oxford University Press; 2003.
 [3] Anbeh, T. (2002) Psychologische Aspekte einer Intensivstation. Studie über beatmete Langzeitpatienten. HeWeTra Verlag,Augsburg, 2. Auflage
 [4] KRINKO - Prävention der nosokomialen beatmungsassoziierten Pneumonie, Bundesgesundheitsblatt 2013 –56:1578-1590
 [5] Specialised tracheal tube enables tracheostomised patients to speak, Eggertsen K., Halkjaer R., Schomkel K.; Fag & Forskning 2019; (1): 54-59
 [6] N. Niers,Subglottische Luftinsufflation bei tracheotomierten Patienten, ACV:“above cuffvo-calisation“ oder „above cuff ventilation“? Eine Übersicht mit praktischer Handreichung. Logos, Jg. 27, Ausgabe 2, 2019