Evaluation and Treatment of Post-Extubation Dysphagia: The Importance of the Speech Pathologist in the Intensive Care Unit

Abstract

Purpose: Post-extubation dysphagia is associated with negative health outcomes including pneumonia, prolonged hospital stay, in-hospital mortality, and inability to discharge home. The purpose of this review article is to summarize published research on screening, evaluating, and treating post-extubation dysphagia. Method: Review of published literature on post-extubation dysphagia to shape best practice guidelines for speech pathologists. Results: Current research on post-extubation dysphagia focuses heavily on screening and evaluation. There are limited data on targeted treatment methods for post-extubation dysphagia. Conclusions: Speech pathologists play a critical role in helping patients safely return to oral alimentation following prolonged endotracheal intubation. Speech pathologists should use the available research to shape best practice guidelines within their facility for who, when, and how to evaluate for dysphagia following extubation.

Evaluation and Treatment of Dysphagia in Public and Private Intensive Care Units (ICUs) in Greece

“…Non-instrumental assessments are usually performed by trained dysphagia specialists, such as a speech-language pathologist (SLP), a physiotherapist, or, in some cases, an occupational therapist. 1 6 19 25 The most common diagnostic test for PED is a bedside swallow evaluation (BSE) performed by an SLP. 3 However, its inability to rule out aspiration and provide objective information on pharyngeal swallow function are major drawbacks.…”

“… 2 39 40 41 42 The value of SLPs as integral members of the ICU MDT is becoming increasingly recognized worldwide, 43 44 45 46 and has been demonstrated in the literature. 25 26 36 39 47 48 49 50 51 52 53 In Greece, only about 5% of public hospitals have a permanent SLP on staff, resulting in a significant knowledge to practice gap regarding critically-ill patients, who remain intubated in ICU and post-ICU settings for an extended period without proper dysphagia referral and management options. 54 Furthermore, despite this condition's clinical importance, there is little research and no national ICU-specific guidelines to manage this population.…”