Augmentative and alternative communication in ventilated patients in intensive care units: A scoping review

The aim of this study was to map the existing evidence on augmentative and alternative communication strategies for adult patients receiving mechanical ventilation in intensive care units.

A scoping review was conducted following the Joanna Briggs Institute methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.

Searches were performed in MEDLINE and CINAHL Complete databases (April 2025). Studies were included if they examined augmentative and alternative communication in adult mechanically ventilated patients in critical care units. Exclusion criteria included paediatric populations, noncritical care settings, letters, opinion papers, and single case reports. Articles published between June 2020 and February 2025 in English, Portuguese, Spanish, or French were eligible, with no restrictions on study design. A full-text review was conducted independently by two authors, and any disagreements were resolved through discussion with a third author. A table was developed to extract the essential information from the eligible studies.

The evidence mapping identified 16 studies, highlighting a growing range of tools to improve communication among mechanically ventilated patients. The identified interventions were categorised into three dimensions: (i) unaided augmentative and alternative communication strategies; (ii) low-tech-assisted augmentative and alternative communication approaches; and (iii) high-tech-assisted augmentative and alternative communication solutions. Augmentative and alternative communication improved patient outcomes, including reduced anxiety, comfort, communication, and satisfaction. Key barriers included patient limitations, insufficient staff training, and device constraints, while facilitators comprised tailored tools, family involvement, and organisational support.

This review demonstrates that a wide range of augmentative and alternative communication strategies are available to support communication in mechanically ventilated adults in the intensive care units. Effective use requires individualised assessment, trained professionals, and integration into routine practice. Further research comparing the effectiveness of different approaches is needed to optimise their implementation and strengthen the evidence base for improving communication, safety, and outcomes in critical care.