What are the possible “side effects” of invasive ventilation?

Invasive ventilation requires a tracheotomy. Inserting a tracheal tube into the opened trachea ensures an adequate supply of air to the lungs. A disadvantage of invasive ventilation is the impairment (or loss) of speech following a tracheotomy.

The use of a tracheostomy tube “bypasses” the larynx, which is responsible for producing the human voice. The ability to speak after a tracheostomy depends on numerous factors: the presence of sufficient spontaneous breathing (which is important for voice production), the presence of a bulbar syndrome (if the tongue is paralyzed, speech is not possible even with sufficient breathing) and the possibility of using a “voice prosthesis” for the tracheostomy tube. Before performing a tracheostomy, an initial assessment of the prospects for speech following the initiation of invasive ventilation should be sought.

Assessing the ability to speak is particularly important for patients who retain their speech function (i.e., do not have severe bulbar syndrome) prior to tracheostomy. Another disadvantage of tracheotomy may be the need for frequent suctioning. The use of a tracheostomy tube, as well as invasive ventilation (and the associated changes in pressure, humidity, flow, and temperature of the inhaled air), can lead to increased secretion production in the trachea and bronchi. The accumulation of secretions is perceived as distressing and requires suctioning through the tracheostomy tube. Suctioning is performed using “suction catheters.” These are thin plastic tubes connected to a suction pump and inserted into the tracheostomy tube. Suctioning can also be achieved through the repeated use of a “cough assist device.”