"Giving voice" to the voiceless: a systematic review of communication aids for ventilated patients in intensive care units

INTRODUCTION: Communication is of utmost importance for every patient, especially for those who are critically ill. Intensive care unit (ICU) patients, who require an artificial endotracheal airway are "voiceless," and the inability to communicate becomes a stressful experience for patients, families and caregivers. Nowadays, several communication aids are available, and scope of this review is to provide an updated and comprehensive understanding of such tools for ventilated ICU patients, identify the most effective options, and evaluate their impact on patient outcomes, healthcare delivery, and patient-provider communication. EVIDENCE ACQUISITION: A systematic literature search was conducted in PubMed, covering studies between 2000 to August 2024. Studies were included if they involved adult voiceless patients in ICUs, utilized any communication aids, and reported outcomes related to communication effectiveness, usability, satisfaction, or clinical. EVIDENCE SYNTHESIS: Out of 1699 initial results, 42 studies met the inclusion criteria and were included in the analysis. No single communication aid was identified as universally adequate for all patients. The effectiveness of communication tools is highly dependent on individual patient capabilities, necessitating a personalized approach. High-tech tools offered significant benefits but faced challenges related to technical issues and training requirements. Low-tech aids were easier to implement but sometimes inadequate for patients with more complex needs. CONCLUSIONS: This systematic review describes the effectiveness and limitations of various communication aids for ventilated ICU patients. Currently, no single tool emerged as superior, rather individualized approaches to select and implement appropriate communication aids are the best strategy for facilitating communication in this population.