The ACoUSTiC Study: Exploring the potential benefits of Above CUff VocaliSation in TraCheostomy: communication, swallowing, decannulation, and cost savings

Background: Approximately 15,000 patients receive a tracheostomy annually in the UK. A tracheostomy has a profound impact on communication, swallowing, and other co-morbidities. Above cuff vocalisation (ACV) involves the application of an external airflow via the subglottic port of the tracheostomy tube. This intervention facilitates restoration of airflow through the laryngo-pharynx, with the potential for vocalisation and improved swallowing. Aim: To explore the potential for ACV to improve outcomes for patients with tracheostomy, investigate the prevalence of complications and safety issues, and explore the cost-effectiveness of ACV. Methods: Six objectives were addressed in the thesis. The current evidence for using ACV in patients with a tracheostomy was examined via a systematic review. Current ACV and tracheostomy weaning practice was investigated using an online survey. Healthcare professionals’ (HCPs) experiences and opinions of ACV were explored using an online survey and individual interviews. An early-stage decision-analytic health economic model was developed to explore the cost-effectiveness of ACV and identify the value of future research. Results: There is limited and low-level evidence available for ACV. There are various potential benefits for patients receiving ACV, but there is a lack of agreement about the extent of these benefits and which patients benefit the most. Severe adverse events and minor complications can occur, and HCPs have developed a cautious approach towards ACV use. There is wide variability in ACV application and a lack of agreement about the optimal approach. HCPs have diverse opinions of ACV, and this is likely due to the uncertainty and variability. ACV is potentially cost-effective according to the data available, and critical drivers for cost-effectiveness have been identified. Conclusions: Further research is needed to reduce the level of uncertainty in the data and to provide more guidance for clinicians regarding ACV adoption decisions and optimal clinical application.