To the Editor:

We read with great interest the work of Lacherade and colleagues (1), which adds to the growing evidence to support the use of subglottic secretion drainage during mechanical ventilation in reducing the incidence of ventilator-associated pneumonia (VAP) (2). We write to highlight an additional benefit of subglottic suctioning ports, particularly within tracheostomy tubes. In our institution, which is a referral center for acute spinal injuries, it is our common practice to use the subglottic suction port on Portex Blue Line Ultra Suctionaid tracheostomy tubes (Smiths Medical Australasia, QLD, Australia) to insufflate air to enable vocalization. This thereby enables the tracheostomy to additionally function as a talking tracheostomy tube (3). In those patients who will not tolerate tracheostomy cuff deflation to enable leak speech, either because of ongoing ventilator dependence, or because of the risk of aspiration, insufflation of air via the subglottic suction port enables short periods of vocalization. Insufflation of gas at 2 to 5 L/minute usually enables sufficient flow to allow patients to vocalize with a whisper-type voice (4).

We are aware of the potential of airway injury and drying with the insufflation of nonhumidified air directly into the larynx and therefore limit both the duration and flow rates used during vocalization. Furthermore, we note the potential to increase the risk of VAP and therefore always aspirate the subglottic secretions fully before insufflating air. The vast majority of our tracheostomies are placed via a percutaneous dilatational technique, and we have experienced no stoma-related problems as described previously with talking tracheostomy tubes (5).

The use of the subglottic suction port has enabled several patients, who otherwise would have been unable, to communicate verbally, thereby significantly improving both their overall care and well-being.

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