Sessions at Airway Fundamentals: Considerations for SLP Decision-Making

June 5–17, 2024 | Online Conference

Distal Outcomes in Airway Management: What's the Target?
James L. Coyle, PhD, CCC-SLP, BCS-S

The SLP’s role in working with patients with anatomical or artificial airways can take different forms. The SLP may contribute to eventual decannulation, help improve functioning while a patient has an artificial airway, and/or mitigate long-term health outcomes that frequently shorten patients’ lives. This session will review the essential knowledge necessary for the SLP to perform as a critically thinking clinician when it comes to management of airway disorders. The speaker will discuss the history of artificial airways, what has been learned, and typical management as well as common issues SLPs could encounter. The session will explore consequences of various conditions that lead to respiratory failure and require artificial airways, focusing on the SLP’s role on the medical team with these patients.

After completing this session, you will be able to:

• identify three conditions for which tracheostomy is frequently deployed
• identify short-term (proximal) and long-term (distal) targets of SLP management of artificial airways
• describe how your clinical methods align with typical treatment targets in patients with artificial airways

The Aerodigestive Tract: Looking at the Body as a Pressurized System
Kristin King, PhD, CCC-SLP

Patients with airway compromise or diseases that affect the respiratory system may have trouble with voicing, swallowing, reflux, mobility, and other functions that have a basis in underlying pressure in the body. This session will examine the human body as a pressurized system, including the interrelationship between functions and pressures; how various disease, anatomical, and physiological changes may impact pressure and functions; and intervention considerations.

After completing this session, you will be able to:

• list at least two major types of pressure that impact the human body and its functions
• list two medical issues or diseases that may negatively impact pressure in the body 
• describe how to address the negative impacts reduced pressure may have on function and recovery

Assessing Your Patient's Respiratory Status
Rachel O'Hare, RRT

This session will introduce the anatomy and physiology of ventilation and respiration as well as discuss the skills needed to assess a patient’s respiratory status. The session will also touch on what respiratory failure looks like and the different therapies used to treat it.

After completing this session, you will be able to:

• summarize the basic principles of ventilation and gas exchange
• identify the signs and symptoms of respiratory distress
• use information gleaned from observing the patient, the monitor, and the chart to determine the patient’s respiratory status
• classify the therapies being used to treat respiratory failure and explain what the therapies indicate about the respiratory status of the patient

Go With the Flow: Noninvasive and Mechanical Ventilation
Thomas Devlin, BS, RRT, ACCS

In this session, a respiratory therapist with advanced pulmonary and critical care knowledge and skill will discuss the two primary forms of ventilation that SLPs typically encounter when working with patients with respiratory failure or pulmonary disease. The presenter will address noninvasive and mechanical ventilation, including external features of a ventilator, common modes of ventilation, ventilator settings, alarms, and associated terminology (FiO2, PEEP).

After completing this session, you will be able to:

• define and explain ventilation, oxygenation, basic anatomy of the lungs, and types of respiratory failure
• identify various types and delivery methods for noninvasive positive pressure ventilation (BiPAP, CPAP)
• define ventilator terminology and identify external features of a ventilator, common modes, and ventilator settings

Tracheostomy Tube Selection and Cuff Management
Priya D. Krishna, ENT

This session is designed for any SLP involved in the inpatient and/or outpatient management for patients who have a tracheostomy tube. The presenter will discuss different tube types and their uses, advantages, disadvantages, and manufacturers. The session will address sizing of tracheostomy tubes and the purpose of inner cannulae and speaking valves, and their relevance to communication and swallowing abilities.

After completing this session, you will be able to:

• discuss the different types of tracheostomy tubes
• identify the advantages and disadvantages of each type of tracheostomy tube
• explain the impact of downsizing a tracheostomy tube on communication and swallowing

Oxygen Therapy Systems and Swallowing Considerations
Rory O'Bryan, MS, CCC-SLP, BCS-S

This session will provide the framework required to evaluate and treat swallowing difficulties for patients who require high flow nasal cannula oxygen therapy. The presenter will review typical breathing and swallowing relationships, highlighting the impact altered respiratory conditions have on the swallow. The session will also include extensive discussion of high flow nasal cannula, its impact on the upper aerodigestive tract, and potential effects on physiologic swallowing. The presenter will discuss the importance of patient candidacy for dysphagia treatments in this population.

After completing this session, you will be able to:

• identify risks for aspiration related to respiratory distress and high oxygen requirements
• summarize the literature investigating effects of high flow oxygen therapy on adult swallowing function
• integrate research findings into clinical decision-making approaches when evaluating and treating swallowing in patients who require high flow nasal cannula oxygen therapy

Invasive and Noninvasive Airway Clearance Management in Adults
Valentina Mocchetti, MS, CCC-SLP

This session will explore the basics of noninvasive and invasive airway clearance management in adults, including various techniques, indications, complications, and the SLP’s role when evaluating communication and swallowing in inpatients or outpatients with respiratory compromise. The presenter will share practical resources for implementing airway clearance techniques and tips for collaborating with an interprofessional team to treat patients with respiratory illness or disease.

After completing this session, you will be able to:

• identify noninvasive and invasive airway clearance techniques that can be used for adults with respiratory compromise
• explain the physiological rationale behind noninvasive and invasive airway clearance techniques and their impact on airway management in individuals with concurrent communication and swallowing impairment
• incorporate airway clearance techniques into a comprehensive communication and swallowing treatment plan of care as part of a multidisciplinary care model

Speaking Valves: Patient Candidacy and Ventilator vs. Nonventilator Use
Candice Devlin, MS, CCC-SLP, BCS-S

This session will address nonventilated and ventilated speaking valve use, patient candidacy, and evidence-based SLP interventions for caring for patients with tracheostomies. The presenter will discuss in-line speaking valve candidacy as well as ventilator settings, steps, compensation, and stop criteria for both vented and nonvented speaking valve use. The session will address questions like: Which patients are appropriate for speaking valves? Can patients use speaking valves while on a ventilator? What is the SLP’s role?

After completing this session, you will be able to:

• identify patients who are candidates for speaking valve use
• describe steps and stop criteria for speaking valve use
• explain ventilator compensation for in-line speaking valve use

The Role of the SLP in Supporting Ventilator Weaning and Decannulation
Roxann Diez Gross, PhD, CCC-SLP

SLPs in health care settings play a fundamental role as team members working toward ventilator liberation and eventual decannulation for patients with tracheostomy tubes. This session will discuss processes and considerations for ventilator weaning and decannulation, including secretion management techniques; impacts of cuff deflation, speaking valve use, or above the cuff phonation; and use of stoma stents. The presenter will also speak to the critical role SLPs play in educating patients and their families about the ventilator weaning and decannulation processes, reducing fear and other negative emotions and making weaning and decannulation trials more successful and comfortable.

After completing this session, you will be able to:

• provide education to patients, families, and staff about the ventilator weaning and decannulation processes
• list the critical predictors of successful and unsuccessful ventilator weaning and discus the SLP’s role in each
• demonstrate using diagrams or models how downsizing tracheostomy tubes impacts upper airway sensation and ability to breathe

Laryngeal Injury After Intubation for Critical Illness: A Physician’s Perspective
Alexander Gelbard, MD

In this session, an otolaryngologist will discuss how endotracheal intubation can impact the larynx and impair functional recovery when it comes to breathing, voicing, and swallowing. The speaker will review the process of intubation, describe the mechanism of laryngeal injury after prolonged intubation, and discuss how early detection and intervention can alter the course of laryngeal injury following endotracheal intubation. This session is a companion to “Post-Extubation Considerations: An SLP’s Perspective.”

After completing this session, you will be able to:

• explain the mechanism of laryngeal injury after intubation for critical illness
• identify acute laryngeal injury based on an endoscopic exam of the larynx
• discuss how early detection and intervention of laryngeal injury post-extubation can impact long-term communication and swallowing outcomes

Post-Extubation Considerations: An SLP’s Perspective
Elizabeth Norberg, MS, CCC-SLP, BCS-S

Endotracheal intubation can have a significant impact on both swallow function and laryngeal integrity. When consulted after extubation, SLPs may have questions such as: How long after extubation should the assessment occur? What can I learn from a bedside swallow exam and is it enough? What findings should prompt an ENT referral? This session will examine current research to inform clinical decision-making and discuss the early utilization of flexible endoscopic evaluation of swallowing (FEES) to identify deficits and guide clinicians to make appropriate referrals. This session is a companion to “Laryngeal Injury After Intubation for Critical Illness: A Physician’s Perspective,” which addresses the topic from an ENT’s perspective.

After completing this session, you will be able to:

• explain consequences of prolonged intubation on functional recovery of breathing, voicing, and swallowing after critical illness
• identify clinical signs and symptoms that warrant further assessment and/or referral

Communication, Cognition, and Swallowing in ICU Patients With Compromised Airways
Jo Puntil, MS, CCC-SLP BCS-S

This session will discuss how initiating speech-language pathology services at the onset of illness can ensure patient-centered care and result in better post-ICU outcomes. The presenter will address the SLP’s role in evaluating and treating medically fragile patients in the ICU as well as the benefits of early communication, cognition, and swallowing evaluations and novel treatments for medically fragile patients. The session will also summarize how SLPs provide communication assistance to patients who are intubated by utilizing augmentative and alternative communication methods. The presenter will also describe the SLP’s role in educating patients and their families regarding how to pragmatically work through cognitive, emotional, and swallowing difficulties in the ICU environment.

After completing this session, you will be able to:

• identify two benefits for early mobilization and communication for intubated patients and their families/caretakers
• distinguish which patients with airway compromise would benefit from various treatment approaches (e.g., pharyngeal electrical stimulation, respiratory muscle strength training, etc.) for best swallowing outcomes
• describe the SLP’s role in educating/counseling patients and care partners in the ICU environment

Rehabilitation of Communication Function Following Critical Illness: Psychosocial Well-Being and Quality of Life
Amy Freeman-Sanderson, PhD, CPSP

Loss of effective communication can occur across the spectrum of critical illness and recovery, particularly with the use of artificial airways, including endotracheal and tracheostomy tubes. Patients report ongoing, long-term impacts to their psychosocial well-being and quality of life due to their lack of ability to communicate immediate care and comfort needs as well as participate in activities with a variety of communication partners. This session will focus on identifying, measuring, and supporting a patient’s psychosocial well-being and quality of life as it relates to communication function.

After completing this session, you will be able to:

• explain the concept of critical illness communication disability
• use the International Classification of Functioning, Disability, and Health (ICF) to discuss the impact of altered communication across the continuum of critical illness, including after discharge from the intensive care unit (ICU)
• discuss tools and outcomes related to evaluating psychosocial impact and quality of life

Complex Case Studies in Airway Management
Ashley M. Lopez, MBA, MS, CCC-SLP, BCS-S, and Marilouise E. Nichols, MS, CCC-SLP, BCS-S

Working with critically ill patients with complex case presentations requires the use of not only evidence-based practices but also creativity to develop individualized treatment programs and advocate for additional services. In this session, the speakers will present a trio of complex cases that necessitated critical thinking, collaboration, and continued intervention for optimal outcomes in airway management.

After completing this session, you will be able to:

• describe the importance of interprofessional communication when evaluating and treating patients with complex airway conditions
• list three benefits of early treatment with speaking valves in unconventional scenarios
• explain the need for clinical pathways and appropriate timing of services to advocate for improved outcomes in patients with complex airway conditions

Caring for Patients With Tracheostomies Across the Continuum of Care: A Panel Discussion
Meredith Oakey Ashford, MS, CCC-SLP; Tiffany A. Oakes, MS, CCC-SLP; and Sarah Fox, MS, CCC-SLP

SLPs may provide services for patients with upper and lower airway disorders, including those with tracheostomies and mechanical ventilation, at any level across the continuum of care. This panel will bring together SLPs from acute care, long-term acute care hospital, and home health care backgrounds to discuss working with this population across different settings. The panel will address similarities and differences across settings, what an SLP going into one of these settings can do to prepare for working with this population, considerations for transitioning between settings, and more.

After completing this session, you will be able to:

• describe the types of care needed for communication and swallowing challenges in patients with tracheostomies and mechanical ventilation across various health care settings
• list competencies and training needed to work with patients with airway disease requiring tracheostomies, with special considerations for each setting
• identify common barriers to care within each setting and how to mitigate them

Distal Outcomes in Airway Management: Expanding Our Targets
James L. Coyle, PhD, CCC-SLP, BCS-S

Management of patients with artificial airways does not end when they can communicate and swallow safely. This session will discuss expanding SLPs’ perspective on appropriate targets, focusing on outcomes to improve the health and quality of life of patients with artificial airways from weaning to decannulation.

After completing this session, you will be able to:

• identify shorter-term (proximal) targets (e.g., establish oral-nasal airflow with artificial airway occlusion; establish phonation with occlusion) and longer-term (distal) targets (e.g., decannulation) for patients with artificial airways
• identify potential sources of post-discharge concern for recidivism among successfully decannulated patients with various pulmonary diseases

"I loved how there were different perspectives on the same subject. I liked the tips and practical strategies that were provided."