Managing post-extubation dysphagia after prolonged intubation: A systematic review of Speech-Language Pathology (SLP) approaches

Introduction Speech-Language Pathology encompasses the assessment, diagnosis, prevention, and treatment of disorders affecting speech, language, voice, hearing, and swallowing. Among these, dysphagia management is crucial, as safe and efficient swallowing depends on the coordinated action of neuromuscular and anatomical structures within the oropharyngeal, laryngeal, and esophageal systems. Disruption of this coordination, particularly after prolonged intubation, can lead to aspiration, malnutrition, and reduced quality of life. Objective To review the literature on swallowing disorders following prolonged intubation, identify associated risk factors, and describe the main Speech-Language Patathology (SLP) assessment and intervention strategies. Methods A systematic review was conducted on swallowing disorders after prolonged endotracheal intubation using PubMed, BVS, and Cochrane databases. Following PRISMA 2020 guidelines, 266 articles were identified, of which 16 met the inclusion criteria. Risk of bias was assessed with the ROBINS-I and Newcastle–Ottawa (NOS) scales. Results Most studies showed low risk of bias and moderate methodological quality. Prolonged intubation was consistently associated with dysphagia. Key risk factors included advanced age, neurological conditions, tracheostomy, inflammation, pneumonia, poor functional status, and extended ICU (Intensive care unit) or hospital stays. Conclusions Dysphagia after prolonged intubation results from multifactorial influences that compromise the swallowing mechanism. Early assessment and targeted Speech-Language Pathology significantly improve swallowing safety, accelerate recovery, and enhance patients' quality of life. These findings highlight the essential role of Speech-Language Pathology (SLP) in post-extubation care and the importance of standardized assessment and rehabilitation protocols.