Summary of findings 2. Non‐vocal communication aid compared to usual care with an aid for adults requiring an artificial airway with or without mechanical ventilator support.

Non‐vocal communication aid compared to usual care with an aid for adults requiring an artificial airway with or without mechanical ventilator support
Patient or population: adults requiring an artificial airway with or without mechanical ventilator support Setting: – Intervention: non‐vocal communication aid Comparison: usual care with an aid
Outcomes	№ of participants (studies)	Impact	Certainty of the evidence (GRADE)	Comments
Proportion able to communicate or phonate	—	—	—	No study measured this outcome.
Health‐related quality of life	—	—	—	No study measured this outcome.
Emotional and psychological distress assessed with: HADS	58 (1 RCT)	HADS depression subscale scores measured at baseline and on study completion favoured the intervention group (Speak for Myself‐Voice communication app) Intervention: mean baseline score 10.5, 95% CI 8.6 to 12.4 to mean postintervention score 8.0, 95% CI 5.8 to 10.2; Control: mean baseline score 6.4, 95% CI 3.9 to 8.9 to mean postintervention score 9.5, 95% CI 6.7 to 12.3, P = 0.006). The difference in the change in HADS anxiety subscale score did not reach statistical significance. Intervention: mean baseline score 12.6, 95% CI 10.5 to 14.6 to mean postintervention score 8.2, 95% CI 6.1 to 10.2; Control: mean baseline score 11.1, 95% CI 8.2 to 14.0 to mean postintervention score 10.3, 95% CI 7.4 to 13.2; P = 0.072). HADS depression and HADS anxiety subscale scores both range from 0 to 21 with higher scores indicating greater depression or anxiety.	⊕⊝⊝⊝ Very lowa,b	Downgraded 2 levels due to very serious risk of bias and 1 level due to imprecision.
ICU length of stay and healthcare costs	—	—	—	No study measured these outcomes.
Adverse events	—	—	—	No study measured this outcome.
CI: confidence interval; HADS: Hospital Anxiety and Depression Scale; ICU: intensive care unit; RCT: randomised controlled trial.
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

^aThe one study contributing data to this outcome was at high risk of selection, performance, and detection bias.
^bOnly one study of 58 participants contributed to this outcome.