Interdisciplinary Management of a Ventilator-Dependent Patient Using the Blom® Tracheostomy in the Burn ICU – A Case Report

Research Objectives: To investigate the interdisciplinary management of a ventilator-dependent patient using the Blom® tracheostomy tube system in the
Burn ICU, in compliance with the American Burn Association standards.

Design: Single subject design. This is a case study.

Setting: A Burn Intensive Care Unit, one of only 123 remaining in the United States, located in a major medical center with a total of 880 beds.

Participants: Participant is a 16 year old male, admitted to the Burn ICU after a car explosion, with burns to 90% of the body. Hospital course complicated by dilated cardiomyopathy, with intubation and sedation for two months before tracheostomy. He remained in the Burn ICU for 14 months.

Interventions: Shiley tracheostomy placed originally for the subject, but he could not produce sufficiently forceful exhale to generate voicing, due to degree of inhalation burn injury, medical instability, and high degree of ventilatory support. During Speech Pathology sessions, using the Blom® tracheostomy and speech cannula, ventilator settings were adjusted to provide mechanical positive pressure to the lungs, allowing sufficient airflow for voicing. Physical Therapy focused on range of motion and positional endurance to improve tolerance of Blom® speech cannula. Occupational Therapy sessions focused on oral facial massage to improve oral range of motion for speaking during Blom® trials.

Main Outcome Measures: Increased duration of time wearing the Blom® speech cannula with functional voicing and verbal communication.

Results: Ability to tolerate Blom® increased from two minutes to 20 minutes over 6 sessions. This allowed verbal communication with family and staff during PT, OT and SLP sessions, and allowed subject to express needs.

Conclusions: The Blom® tracheostomy is a viable alternative for Burn ICU ventilator-dependent patients who cannot wean from mechanical ventilation and are unable to benefit from other types of speaking valves. Additional study is required to determine broader application of this device in the Burn ICU and other complex ICU populations.

Author(s) Disclosures: Nothing to disclose, no conflicts of interest.