Managing oral and respiratory secretions after severe acquired brain injury (ABI) is complex and requires coordinated multidisciplinary assessment and intervention. Impairments in swallowing, coughing, posture and awareness contribute to secretion accumulation, increasing risks of aspiration and infection. This article outlines the pathophysiology of saliva and mucus changes in ABI, their clinical impact, and structured approaches to assessment including bedside indicators, dysphagia evaluation and tracheostomy-related considerations. Non-pharmacological, pharmacological and procedural treatments—ranging from airway clearance techniques to anticholinergics and salivary gland botulinum toxin—are reviewed. A pragmatic, individualised management pathway is proposed to optimise secretion control and support rehabilitation outcomes.
Bradley et al. (Wed,) studied this question.