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INTERDISCIPLINARY CARE IN DYSPHAGIA OF NEUROLOGICAL

ORIGIN: INTERFACES BETWEEN NURSING AND SPEECH THERAPY

Juliana Marques de Souza1

Alexsandro N. Oliveira2

Diely Aparecida de Oliveira Soares3

Marilu de Souza Franco4

Sara Luciana de Andrade5

Fábio Caxico de Abreu Júnior6

Paulo Henrique Dias Trofelli7

Luís Carlos Bueno8

Thiago Inocêncio Trofelli9

Cleber Aparecido Medeiros da Silva10

1 Bacharel em Fonoaudiologia pela Universidade de Guarulhos UNG; Especialista em Fono-

audiologia Hospitalar pela UNG - Universidade de Guarulhos – E-mail: julianamsfono@gmail.lcom

Orcid: https://orcid.org/0009-0008-9123-3753

2 Mestrado em gestão de Cuidados da Saúde pela Universidade da Amazônia – UNAMA –

E-mail: ano_alexsandro @yahoo.com – Orcid: https://orcid.org/0009-0001-7023-7092

3 Bacharel em Fisioterapia pela Universidade Braz Cubas; Especialista em Fisioterapia Intensi-

va Adulto pela FABIC Physio Cursos. E-mail:  siodielyoliveira@hotmail.com – Orcid: https://orcid.

org/0009-0003-6356-5500

4 Mestranda em Gestão de Cuidados da Saúde pela Must University. Professora do Curso de

Enfermagem na Universidade de Mogi das Cruzes – UMC.

5 Mestranda pela Universidade Ivy Enber Christian University – E-mail: drasaraandrade@

yahoo.com - ORCID iD: https://orcid.org/0009-0004-6094-502X

6 Mestrando em Saúde Pública pela Universidade IV Enber Christian University. E-mail:

fabio.caxico01@gmail.com - ORCID: https://orcid.org/0009-0003-8606-5314

7 Bacharel em Enfermagem pela Universidade de Mogi das Cruzes – UMC. E-mail: paulot-

dias5@gmail.com - Orcid: https://orcid.org/0009-0006-6733-8235

8 Especialista em urgência e emergência , UTI Adulto , Cardiologia e Hemodinâmica , docência

do ensino Superior Faculminas https://orcid.org/0009-0005-2741-9471

9 Mestrado em Políticas Públicas pela Universidade de Mogi das Cruzes - UMC. E-mail: thia-

goinocenciotrofelli@gmail.com - Orcid: https://orcid.org/0009-0002-8938-8525

10 Especialista em Saúde Mental pela FACULESTE– Universidade de Minas Gerais. E-mail: cle-

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Samira Aparecida Pogianela Alvim11

Abstract: Objective: To analyze, in light of recent scientiﬁ c literature, the interfaces between nursing

and speech-language pathology in the interdisciplinary care of critically ill patients with neurogenic

dysphagia, emphasizing patient safety in the intensive care unit. Method: An integrative literature

review was conducted, searching the PubMed/MEDLINE, LILACS, and SciELO databases for

publications from 2021 to 2026. DeCS/MeSH descriptors related to dysphagia, swallowing disorders,

nursing, speech-language pathology, intensive care, stroke, and mechanical ventilation were used,

combined with Boolean operators. Results: The literature shows that neurogenic dysphagia—

particularly following stroke, prolonged orotracheal intubation, and tracheostomy—is associated

with aspiration pneumonia, malnutrition, dehydration, prolonged hospital stays, mortality, and

poorer functional recovery. Five thematic categories were identiﬁ ed: early identiﬁ cation and risk

stratiﬁ cation; clinical, ventilatory, and hemodynamic monitoring; nursing interventions; specialized

speech-language pathology care; and quality-of-care indicators in the ICU. Conclusion: Safe care for

critically ill patients with dysphagia requires the integration of nursing clinical reasoning, specialized

speech-language pathology assessment, institutional protocols, invasive monitoring when indicated,

hemodynamic support, mechanical ventilation management, judicious use of vasoactive drugs, and

evidence-based decision-making. An interdisciplinary approach reduces avoidable risks and improves

the transition between critical care, rehabilitation, and functional recovery.

Keywords: Dysphagia; Swallowing Disorders; Nursing; Speech-Language Pathology; Intensive Care

Units; Stroke; Patient Safety.

binhoo79@gmail.com – Orcid: https://orcid.org/0009-0006-0544-1472

11 Mestranda em Gestão de Cuidados da Saúde pela Must University. Professora do Curso de

Enfermagem na Universidade de Mogi das Cruzes – UMC.

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INTRODUCTION

The intensive care unit (ICU) is a highly complex care environment, intended for the care of

patients with clinical instability, acute organ failure, need for continuous monitoring, hemodynamic

support, invasive or non-invasive mechanical ventilation, use of vasoactive drugs, and permanent

multidisciplinary surveillance. In this context, dysphagia of neurological origin represents a highly

relevant clinical condition, as it directly interferes with airway safety, nutrition, hydration, drug

administration, prevention of bronchial aspiration, and the functional evolution of critically ill patients.

Neurogenic dysphagia may result from stroke, traumatic brain injury, neurodegenerative

diseases, encephalopathies, spinal cord injuries, neuropathies, ICU-acquired myopathies, delirium,

decreased level of consciousness, and sequelae of prolonged orotracheal intubation. In critically ill

patients, this condition often overlaps with factors such as ICU-acquired muscle weakness, sedation,

cough reﬂ ex alteration, reduced pharyngeal sensitivity, presence of tracheal cannula, reintubation,

prolonged mechanical ventilation time, and respiratory instability.

Recent epidemiological data demonstrate the magnitude of the problem. A systematic review

and meta-analysis published in 2024 estimated an overall prevalence of post-stroke dysphagia of

46.6%, with an association with respiratory infections, pneumonitis, persistence of dysphagia after

discharge, and increased mortality (Song et al., 2024). In critically ill patients undergoing orotracheal

intubation, a 2024 meta-analysis estimated a pooled incidence of post-extubation dysphagia of 36%,

varying according to the time of evaluation, duration of intubation, and diagnostic method used (Yu

et al., 2024).

The clinical relevance of dysphagia in the ICU goes beyond the difﬁ culty of oral feeding.

It is a marker of vulnerability, respiratory risk, and the need for interdisciplinary surveillance. The

literature associates post-extubation dysphagia with pneumonia, aspiration, reintubation, prolonged

hospital stay, increased costs, reduced quality of life, and short- and long-term mortality. Recent

studies reinforce that the systematic identiﬁ cation of dysphagia should be incorporated into the safety

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routine of critically ill patients, especially after extubation, in neurological patients, tracheostomized

or with altered level of consciousness (Bertschi et al., 2025; Spronk et al., 2022).

From this perspective, nursing occupies a strategic position, as it remains at the bedside for

24 hours, monitors clinical signs, ventilatory and hemodynamic parameters, administers medications,

monitors food acceptance, identiﬁ es coughing, choking, wet voice, desaturation, changes in breathing

patterns and early signs of bronchial aspiration. Speech therapy, in turn, acts in the specialized

evaluation of swallowing, in the indication of safe food consistencies, in functional rehabilitation, in

the orientation of compensatory strategies, in the management of tracheostomy, and in the interface

with the medical team, physiotherapy, nutrition, and nursing.

The research problem that guides this study is: what recent evidence supports interdisciplinary

care between nursing and speech-language pathology in the care of critically ill patients with dysphagia

of neurological origin in the ICU?

The study is justiﬁ ed by the need to qualify institutional protocols, reduce avoidable adverse

events, strengthen evidence-based decision-making, and expand the integration between clinical

nursing evaluation and specialized speech-language pathology evaluation. Neurogenic dysphagia,

when neglected, compromises essential indicators of quality of care, such as aspiration-associated

pneumonia, duration of mechanical ventilation, length of ICU stay, reintubation rate, nutritional

adequacy, bronchial aspiration events, and mortality.

Thus, the objective of this study was to analyze recent scientiﬁ c evidence on interdisciplinary

care in dysphagia of neurological origin, highlighting the interfaces between nursing and speech

therapy in the care of critically ill patients in ICUs.

METHODOLOGY

It is an integrative literature review, a method that allows gathering, analyzing and

synthesizing evidence from different methodological designs, favoring an expanded understanding of

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complex clinical phenomena and subsidizing evidence-based practice.

The search was structured in the PubMed/MEDLINE, LILACS, and SciELO databases,

considering publications between 2021 and 2026. DeCS/MeSH controlled descriptors and free terms

in Portuguese and English were used: “Dysphagia”, “Deglutition Disorders”, “Neurogenic Dysphagia”,

“Stroke”, “Stroke”, “Cerebral Vascular Accident”, “Critical Care”, “Intensive Care Units”, “Nursing

Care”, “Nursing”, “Speech-Language Pathology”, “Speech-Language Pathology”, “Mechanical

Ventilation”, “Mechanical Ventilation”, “Post-extubation Dysphagia”, “Aspiration Pneumonia” and

“Patient Safety”.

The search strategies were constructed with Boolean operators: (“Deglutition Disorders” OR

“Dysphagia” OR “Neurogenic Dysphagia”) AND (“Nursing Care” OR “Nursing”) AND (“Speech-

Language Pathology” OR “Speech Therapy”); (“Post-extubation Dysphagia” OR “Dysphagia”)

AND (“Intensive Care Units” OR “Critical Care”) AND (“Mechanical Ventilation”); (“Stroke” OR

“Stroke”) AND (“Dysphagia” OR “Deglutition Disorders”) AND (“Screening” OR “Assessment”);

and (“Dysphagia” AND “Patient Safety” AND “Intensive Care”).

Original scientiﬁ c articles, systematic reviews, meta-analyses, guidelines, consensus, and

implementation studies published between 2021 and 2026, available in full text or structured abstract,

in Portuguese, English, or Spanish, that addressed dysphagia of neurological origin, post-extubation

dysphagia, swallowing screening, nursing care, speech therapy, ICU, patient safety, or interdisciplinary

management, were included.

Pediatric studies were excluded when not applicable to critically ill adult patients, reports

without a clear methodological basis, editorials without direct clinical contribution, duplicate articles,

exclusively outpatient studies unrelated to critical care, and publications prior to 2021, except when

cited indirectly by recent guidelines.

The analysis of the studies was carried out by critical reading, extraction of the main ﬁ ndings

and organization into thematic categories. No meta-analysis was performed due to the heterogeneity

of the designs, populations, assessment instruments, and clinical outcomes investigated.

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RESULTS

The literature analyzed demonstrated that the care of critically ill patients with neurogenic

dysphagia requires an interdisciplinary approach, structured by protocols, sequential evaluation and

effective communication between nursing, speech therapy, medicine, physiotherapy, nutrition and

clinical pharmacy. The ﬁ ndings were organized into ﬁ ve thematic categories.

Chart 1 – Synthesis of the studies selected in the integrative review

Author/year Outline/focus Key ﬁ ndings Contribution to nursing and spee-

ch therapy

Dziewas et al. (2021) European guideline on

post-stroke dysphagia

Recommends systematic scree-

ning before diet, liquids, or oral

medications.

It supports institutional protocol

and early activation of speech

therapy.

Boaden et al. (2021) Cochrane review of scree-

ning for aspiration risk in

stroke

It evidences the need for scre-

ening and caution instruments

with methodological variability.

Supports training of nurses for

risk recognition.

Evans et al. (2021) International Sepsis and

Septic Shock Guideline

It prioritizes hemodynamic stabi-

lization, vasopressors, and orga-

nic support in unstable patients.

It guides the decision not to relea-

se orally in shock, hypoperfusion

or respiratory instability.

Warnecke et al.

(2021)

Systematic review and

classiﬁ cation proposal for

neurogenic dysphagia

It relates neurological topography,

pathophysiology, and clinical ma-

nifestations of dysphagia.

It strengthens clinical reasoning

in the correlation between neuro-

logical injury and risk of aspira-

tion.

Spronk et al. (2022) International cross-sec-

tional study DICE in ICU

It showed gaps in the availability

of speech therapy and in the stan-

dardized identiﬁ cation of dyspha-

gia in the ICU.

It reinforces the need for multi-

professional protocols and care

indicators.

Troll et al. (2023) GUSS-ICU Validation An instrument has demonstra-

ted usefulness for screening for

post-extubation dysphagia at the

bedside.

It can support initial screening,

without replacing specialized

speech-language pathology

evaluation.

Song et al. (2024) Systematic review and

meta-analysis on post-s-

troke dysphagia

It estimated an overall prevalence

of 46.6% and an association with

pneumonia and mortality.

It justiﬁ es early screening and

continuous nursing surveillance.

Yu et al. (2024) Systematic review and

meta-analysis on post-ex-

tubation dysphagia

It estimated a pooled incidence

of 36% in critically ill intubated

patients.

It supports systematic evaluation

after extubation and prevention of

bronchial aspiration.

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Chen et al. (2024) Systematic review and

meta-analysis of post-ex-

tubation interventions

It analyzed the efﬁ cacy and safety

of interventions for dysphagia af-

ter prolonged intubation.

It supports interdisciplinary reha-

bilitation and clinical response

monitoring.

Bertschi et al. (2025) Narrative review on pos-

t-extubation dysphagia in

ICU

It updates epidemiology, mecha-

nisms, diagnosis and clinical ma-

nagement.

It integrates mechanical venti-

lation, ICU-acquired weakness,

sepsis, and critical care.

Nielsen et al. (2025) Nurse-led triage imple-

mentation study

It demonstrated the feasibility of

triage by nurses, with barriers to

adherence and documentation.

It highlights permanent educa-

tion, communication and clinical

governance.

Trapl-Grunds-

chober et al. (2025)

Study on oral drug admi-

nistration in post-stroke

dysphagia

It highlighted risks and challen-

ges in the administration of solid

drugs in dysphagic patients.

It reinforces the interface betwe-

en nursing, clinical pharmacy and

speech therapy.

Source: prepared by the author based on the selected studies (2026).

Early identiﬁ cation and risk stratiﬁ cation

The studies reinforce that early screening for dysphagia is essential to reduce aspiration

pneumonia, malnutrition, dehydration, and mortality. In stroke, European guidelines recommend

systematic screening for dysphagia in all patients, especially prior to the release of oral diet, oral

medications, or liquids (Dziewas et al., 2021).

In the ICU, post-extubation dysphagia has a high incidence and can occur even in patients

without previous neurological disease. However, neurological patients are at increased risk due to

motor, sensory, and cognitive deﬁ cits, alterations in consciousness, and impairment of airway protective

reﬂ exes. The validation of the GUSS-ICU demonstrated that standardized instruments can support

the identiﬁ cation of the risk of post-extubation dysphagia, although they do not replace specialized

speech-language pathology evaluation or instrumental tests, such as FEES, when available (Troll et

al., 2023).

For nursing, risk stratiﬁ cation should consider neurological diagnosis, intubation time,

presence of tracheostomy, reintubation, level of consciousness, RASS scale, ability to maintain

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sedation, effective cough, secretion control, respiratory stability, peripheral oxygen saturation,

ventilatory pattern, use of vasoactive drugs and ongoing hemodynamic support.

Clinical, ventilatory and hemodynamic monitoring

The decision about starting swallowing screening, releasing it orally, or referring it for speech-

language pathology evaluation should be integrated with the patient’s overall clinical condition. In the

ICU, it is not safe to evaluate swallowing in isolation, without considering invasive monitoring, mean

arterial pressure, respiratory rate, need for supplemental oxygen, mechanical ventilation parameters,

level of sedation, delirium, fatigue, and tissue perfusion.

Patients in septic shock, post-cardiorespiratory arrest instability, persistent hypoxemia,

increasing use of norepinephrine or other vasopressor, metabolic acidosis, neurological downgrading,

or high risk of reintubation should not be submitted to oral diet early without careful evaluation. The

Surviving Sepsis Campaign guidelines guide a protocolized approach to sepsis and septic shock,

including hemodynamic support, clinical goal-guided resuscitation, vasopressors when indicated, and

early enteral nutrition in patients able to receive it (Evans et al., 2021).

Similarly, the American Heart Association’s cardiopulmonary resuscitation and post-arrest

care guidelines highlight initial stabilization, respiratory management, treatment of reversible causes,

hemodynamic control, and post-return care of spontaneous circulation prior to intensive functional

rehabilitation (American Heart Association, 2025). The relationship with dysphagia is direct: post-

arrest, post-stroke or post-sepsis patients often present neurological alterations, weakness, delirium and

risk of aspiration, requiring nursing to integrate critical clinical reasoning and functional assessment.

Nursing interventions in the care of dysphagic patients

Nursing interventions are decisive for the prevention of adverse events. Among the main

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actions, the following stand out: keeping the head of the bed elevated between 30º and 45º; assess

the level of consciousness before any oral offering; observe coughing, choking, vocal alterations,

oral leakage, fatigue during feeding, desaturation, tachypnea, and accumulation of secretions;

communicate speech therapy early; record ﬁ ndings in a standardized way; ensure strict oral hygiene;

control the administration of oral medications; and suspend diet when there are signs of bronchial

aspiration.

The implementation of dysphagia screening conducted by ICU nurses proved to be possible,

although it depends on training, institutional support, adequate documentation, and integration with

the multiprofessional team. An implementation study published in 2025 pointed out that nurse-led

screening can facilitate safe oral intake and identify patients who need specialized evaluation, but it

also highlighted barriers related to protocol adherence, communication, and documentation (Nielsen

et al., 2025).

In the critically ill patient, clinical nursing reasoning must answer objective questions: is

the patient awake and responsive? Is it hemodynamically stable? Are you using vasoactive drugs in

a stable or increasing dose? Does it maintain adequate saturation? Do you have an effective cough?

Does it control secretions? Do you have delirium? Do you show signs of respiratory fatigue? Do you

have a speech therapy prescription or oral route restriction? These variables should guide decision-

making and prevent automated conduct.

Specialized speech-language pathology and interfaces with nursing

Speech therapy works in the clinical and instrumental evaluation of swallowing, classiﬁ cation

of dysphagia severity, deﬁ nition of safe food consistencies, prescription of compensatory strategies,

rehabilitation of the oropharyngeal muscles, management of tracheostomy, adaptation of the speech

valve when indicated, team guidance and monitoring of the progression of the oral route.

Integration with nursing is essential because the effectiveness of speech-language

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pathology guidance depends on safe execution in bed: positioning, food supply at the appropriate

pace, supervision, volume control, identiﬁ cation of aspiration signs, maintenance of oral hygiene,

medication administration compatible with dysphagia and recording of complications. Nursing does

not replace speech therapy, but expands clinical surveillance and operationalizes recommendations

in continuous care.

Recent consensuses on the management of swallowing disorders in the ICU advocate a

multiprofessional approach, with protocols for screening, specialized evaluation, oral route criteria,

tracheostomy management, and respiratory safety (Likar et al., 2024). Interprofessional projects with

the participation of speech therapy, nursing, physiotherapy, medicine and occupational therapy also

demonstrate potential to reduce tracheal cannula time, accelerate safe decannulation and reduce ICU

stay (Konradi et al., 2025).

Quality and Critical Patient Safety Indicators

Dysphagia should be incorporated into the ICU care quality indicators. Among the relevant

indicators, the following stand out: percentage of extubated patients screened for dysphagia before the

ﬁ rst oral diet; time between extubation and swallowing screening; time between risk identiﬁ cation and

speech-language pathology evaluation; rate of aspiration pneumonia; episodes of bronchial aspiration;

rate of reintubation associated with aspiration; adequacy of the food route; time of mechanical

ventilation; length of stay in the ICU; adherence to oral hygiene; compliance with food consistency

prescription; and adverse events related to the administration of oral medications.

These indicators connect dysphagia care to the principles of critical patient safety, harm

prevention, effective communication, teamwork, rational use of protocols, and continuous clinical

surveillance.

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DISCUSSION

The ﬁ ndings of this review demonstrate that neurogenic dysphagia should be understood as a

high-impact clinical condition, and not only as a functional alteration of diet. In critically ill patients,

dysphagia expresses the interaction between neurological damage, muscle weakness, sensorimotor

impairment, respiratory changes, hemodynamic instability, and consequences of intensive support.

Recent literature reinforces that post-stroke dysphagia remains highly prevalent and clinically

relevant. The meta-analysis by Song et al. (2024) demonstrated an overall prevalence of 46.6%, with

a higher risk in patients with hemorrhagic stroke, advanced age, atrial ﬁ brillation, hypertension,

previous stroke, and greater neurological severity. This ﬁ nding requires that neurological ICU nursing

maintain increased vigilance from admission, not only at the time of feeding.

In patients undergoing mechanical ventilation, post-extubation dysphagia is a frequent and

underdiagnosed complication. Yu et al. (2024) estimated an incidence of 36% in critically ill intubated

patients, while cohort studies indicate an association with long-term mortality and poorer functional

recovery. This reveals that successful extubation from the respiratory point of view does not necessarily

mean safe recovery of swallowing. The post-extubation evaluation should be understood as a step of

airway safety and not only as dietary release.

Nursing performance becomes central due to its ability to identify clinical changes in real

time. The nurse must correlate neurological, ventilatory and hemodynamic ﬁ ndings before releasing

or maintaining oral restriction. A patient with extensive stroke, negative RASS, weak cough, use

of norepinephrine, tachypnea, and increasing oxygen requirement is at high risk for aspiration and

respiratory deterioration. In this scenario, the safe conduct is to keep the oral route suspended, ensure

nutrition by alternative route as prescribed, activate speech therapy, discuss with the medical team

and carefully record the clinical justiﬁ cation.

The interface with speech therapy allows for greater diagnostic and therapeutic accuracy.

While nursing identiﬁ es signs of risk and continuously monitors the patient’s response, speech therapy

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deﬁ nes functional parameters of swallowing, food consistencies, need for instrumental exams,

therapeutic exercises and compensatory strategies. The GUSS-ICU, validated in 2023, demonstrated

good discriminative capacity for identifying post-extubation dysphagia, with high sensitivity when

compared to FEES, reinforcing the potential of standardized instruments in a critical environment

(Troll et al., 2023).

However, the adoption of instruments should not generate false security. Dysphagia in

the ICU is dynamic. The patient may improve or worsen according to fatigue, delirium, secretion,

sepsis, sedation, ventilatory alteration or neurological progression. Thus, even after an initial

favorable screening, nursing should maintain vigilance during meals, medication administration, and

mobilization. The evaluation should be reprocessed in the event of cough, drop in saturation, vocal

alteration, fever, increased secretion, new pulmonary inﬁ ltrate, or altered level of consciousness.

The administration of solid drugs in dysphagic patients represents a critical safety point.

Improperly crushed tablets, opened capsules without pharmaceutical evaluation, administration

with thin liquids, or mixing in incompatible foods may cause aspiration, loss of pharmacological

efﬁ cacy, obstruction of probes, and adverse events. Recent studies indicate that drug administration

in dysphagic post-stroke patients is a relevant challenge for nursing, requiring integration with clinical

pharmacy and speech therapy (Trapl-Grundschober et al., 2025).

In the context of sepsis, the application of the Surviving Sepsis Campaign should guide

clinical prioritization. Patients in sepsis or septic shock require infectious control, antibiotic therapy,

volume replacement, vasopressors, perfusion monitoring, lactate, and hemodynamic stability prior

to advanced functional interventions. Dysphagia may aggravate the risk of aspiration pneumonia,

but swallowing assessment should only occur when there is minimum stability for safe participation.

Therefore, dysphagia protocols do not compete with sepsis protocols; they articulate on the continuum

of critical care.

Similarly, ACLS protocols and post-cardiorespiratory arrest care target airway stabilization,

ventilation, circulation, and reversible causes. After return of spontaneous circulation, patients may

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present hypoxic-ischemic encephalopathy, need for mechanical ventilation, sedation, hemodynamic

instability, and risk of aspiration. The reintroduction of oral diet in this group should be delayed, judicious

and interdisciplinary, respecting the neurological level, airway protection and cardiorespiratory

stability.

The discussion also points to educational and managerial implications. The ICU must have

an institutional protocol for post-extubation dysphagia and neurogenic dysphagia, with objective

screening criteria, speech therapy activation ﬂ ows, standardization of food consistencies, oral hygiene

guidance, criteria for diet suspension, and monitoring indicators. The continuing education of the

nursing team is essential to reduce care variations and ensure that triage is not just a documentary

task, but a well-founded clinical action.

As a limitation, this review presents a narrative and integrative synthesis, without its own

meta-analysis and without a formal assessment of the risk of bias of all the included studies. In

addition, the heterogeneity of screening instruments, populations, post-extubation evaluation times,

and diagnostic criteria makes direct comparisons difﬁ cult. It is recommended that future Brazilian

studies evaluate interdisciplinary protocols in ICUs, the impact of nurse-led triage, time to speech

therapy, the occurrence of aspiration pneumonia, and the cost-effectiveness of implementing dysphagia

prevention programs.

CONCLUSION

Interdisciplinary care in dysphagia of neurological origin is an essential component of the

safety of critically ill patients in the ICU. Recent evidence shows that post-stroke dysphagia and post-

extubation dysphagia have a high prevalence, association with aspiration pneumonia, malnutrition,

dehydration, prolonged hospitalization, reintubation, mortality, and poorer functional recovery.

Nursing plays a strategic role in early identiﬁ cation, continuous clinical monitoring,

maintenance of airway safety, oral hygiene, positioning, surveillance during feeding, safe

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administration of medications, documentation and risk communication. Speech therapy complements

this process through specialized evaluation, deﬁ nition of consistencies, swallowing rehabilitation,

tracheostomy management and technical guidance to the team.

The integration between nursing and speech therapy should be articulated with ICU protocols,

including mechanical ventilation management, invasive monitoring, hemodynamic support, use of

vasoactive drugs, Surviving Sepsis Campaign, ACLS, and patient safety indicators. Decision-making

should be evidence-based, but also contextualized by the patient’s individual clinical condition,

respiratory stability, perfusion, level of consciousness, and functional capacity.

It is concluded that interdisciplinary protocols, continuing education, systematic screening,

timely speech-language pathology evaluation and care indicators are essential to reduce avoidable

complications and qualify the care of critically ill patients with neurogenic dysphagia.

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