Interventions in post-extubation dysphagia: a scoping review: a scoping review

Paulo Azevedo; Margarida Oliveira; Manuel Saraiva; Joana Vila Pouca; Isabel Oliveira

doi:10.33194/rper.2026.41655

Authors

Paulo Azevedo Escola Superior de Saúde Norte da Cruz Vermelha Portuguesa, https://ror.org/015nkmw43, Oliveira de Azemíes, Portugal https://orcid.org/0000-0003-4099-3329
Margarida Oliveira ULS de Santo António, https://ror.org/02m9pj861, Porto, Portugal https://orcid.org/0000-0003-0703-8776
Manuel Saraiva ULS de Santo António, https://ror.org/02m9pj861, Porto, Portugal https://orcid.org/0000-0002-5334-8153
Joana Vila Pouca ULS de Gaia e Espinho, https://ror.org/042jpy919, Vila Nova de Gaia, Portugal https://orcid.org/0009-0000-6642-9369
Isabel Oliveira Escola Superior de Enfermagem de Coimbra, https://ror.org/03c3y8w73, Coimbra, Portugal https://orcid.org/0000-0001-6627-3907

DOI:

https://doi.org/10.33194/rper.2026.41655

Keywords:

Nursing, Critical Care, Deglutition disorders, Mechanical ventilation, Airway Extubation

Abstract

Introduction: Post-extubation dysphagia (PED) has a negative impact on the recovery of critically ill patients. However, evidence for interventions to restore swallowing function is scarce, therefore, mapping relevant interventions is essential to support nursing care.

Methodology: Scoping review following the Joanna Briggs Institute methodology. A search of MEDLINE (via PubMed), Cochrane, Scielo, ScienceDirect and CINAHL databases was carried out in October 2023. An additional search was conducted in the grey literature. Data extraction was based on the following criteria: adult patients in intensive care, extubated after more than 48 hours of invasive mechanical ventilation (population), PED (concept) and intensive care units (context).

Results: 1892 articles were retrieved, plus 59 found in the grey literature. 14 articles were included for analysis. Muscle strengthening exercises and postural adjustments are the most reported rehabilitation and compensatory strategies.

Discussion: PED has become a focus of attention due to its high incidence and prevalence. From the analysis, it was not possible to determine when interventions should be started after extubation, what dose, frequency and duration should be used, or what follow-up is required for these patients.

Conclusion: This review mapped compensatory and rehabilitation interventions for PED in critical care patients. Evidence remains insufficient to define optimal timing, dose, frequency, duration, or follow-up, supporting the need for structured protocols and further intervention studies.

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References

1. Bertschi D, Rotondo F, Waskowski J, Venetz P, Pfortmueller CA, Schefold JC. Post-extubation dysphagia in the ICU−a narrative review: epidemiology, mechanisms and clinical management (Update 2025). Crit Care. 2025 Dec 1;29(1):244. doi:10.1186/S13054-025-05492-7

2. Printza A, Tedla M, Frajkova Z, Sapalidis K, Triaridis S. Dysphagia Severity and Management in Patients with COVID-19. Curr Health Sci J. 2021;47(2):147–56. doi:10.12865/CHSJ.47.02.01

3. Armas-Navarro LP, Santana-Padilla YG, Mendoza-Segura L, Ramos-Díaz M, Santana-López BN, Alcaraz-Jiménez JA, et al. La disfagia en cuidados intensivos, un problema real: análisis de factores de riesgo. Enferm Intensiva. 2023 Jul 1;34(3):115–25. doi:10.1016/J.ENFI.2022.08.001

4. McIntyre M, Doeltgen S, Dalton N, Koppa M, Chimunda T. Post-extubation dysphagia incidence in critically ill patients: A systematic review and meta-analysis. Aust Crit Care. 2021 Jan 1;34(1):67–75. doi:10.1016/J.AUCC.2020.05.008

5. Bordejé Laguna L, Marcos-Neira P, de Lagrán Zurbano IM, Marco EM, Guisasola CP, Viñas Soria CD, et al. Dysphagia and mechanical ventilation in SARS-COV-2 pneumonia: It’s real. Clin Nutr. 2021 Dec 1;41(12):2927–33. doi:10.1016/j.clnu.2021.11.018

6. Schefold JC, Berger D, Zürcher P, Lensch M, Perren A, Jakob SM, et al. Dysphagia in mechanically ventilated ICU patients (Dynamics): A prospective observational trial. Crit Care Med. 2017;45(12):2061–9. doi:10.1097/CCM.0000000000002765

7. Brodsky MB, Huang M, Shanholtz C, Mendez-Tellez PA, Palmer JB, Colantuoni E, et al. Recovery from dysphagia symptoms after oral endotracheal intubation in acute respiratory distress syndrome survivors: A 5-year longitudinal study. Ann Am Thorac Soc. 2017 Mar 1;14(3):376–83. doi:10.1513/ANNALSATS.201606-455OC

8. Zuercher P, Moret CS, Dziewas R, Schefold JC. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. Crit Care. 2019 Mar 28;23(1):103. doi:10.1186/S13054-019-2400-2

9. Duncan S, McAuley DF, Walshe M, McGaughey J, Anand R, Fallis R, et al. Interventions for oropharyngeal dysphagia in acute and critical care: a systematic review and meta-analysis. Intensive Care Med. 2020 Jul 1;46(7):1326. doi:10.1007/S00134-020-06126-Y

10. Peters M, Godfrey C, McInerney P, Munn Z, Tricco A, Khalil H. Chapter 11: Scoping reviews. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. JBI; 2020. doi:10.46658/JBIMES-20-12

11. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372:n71. doi:10.1136/BMJ.N71

12. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 2018 Oct 2;169(7):467–73. doi:10.7326/M18-0850

13. Oliveira IJ, Azevedo PM. Interventions in post-extubation dysphagia: a scoping review protocol. 2023. doi:10.17605/OSF.IO/KCTQ9

14. Bath PM, Lee HS, Everton LF. Swallowing therapy for dysphagia in acute and subacute stroke. Cochrane Database Syst Rev. 2018;10(10):CD000323. doi:10.1002/14651858.CD000323.pub3

15. Clayton NA, Ward EC, Nicholls C, Giannone R, Skylas K, Maitz PK. The addition of respiratory muscle strength training to facilitate swallow and pulmonary rehabilitation following massive tissue loss and severe deconditioning: A case series. Aust Crit Care. 2022 Mar 1;35(2):210–6. doi:10.1016/J.AUCC.2021.03.003

16. El Gharib AZG, Berretin-Felix G, Rossoni DF, Seiji Yamada S. Effectiveness of Therapy on Post-Extubation Dysphagia: Clinical and Electromyographic Findings. Clin Med Insights Ear Nose Throat. 2019 Jan 12;12:117955061987336. doi:10.1177/1179550619873364

17. Lima MS de, Sassi FC, Medeiros GC de, Ritto AP, Andrade CRF de. Evolução funcional da deglutição em pacientes com COVID-19 internados em UTI. Codas. 2020;32(4):e20200222. doi:10.1590/2317-1782/20192020222

18. Macht M, Wimbish T, Clark BJ, Benson AB, Burnham EL, Williams A, et al. Diagnosis and treatment of post-extubation dysphagia: Results from a national survey. J Crit Care. 2012 Dec;27(6):578–86. doi:10.1016/j.jcrc.2012.07.016

19. Nielsen AH, Kaldan G, Nielsen BH, Kristensen GJ, Shiv L, Egerod I. Intensive care professionals’ perspectives on dysphagia management: A focus group study. Aust Crit Care. 2023 Jul;36(4):528–35. doi:10.1016/j.aucc.2022.04.004

20. Regan J, Walshe M, Lavan S, Horan E, Gillivan Murphy P, Healy A, et al. Post‐extubation dysphagia and dysphonia amongst adults with COVID‐19 in the Republic of Ireland: A prospective multi‐site observational cohort study. Clin Otolaryngol. 2021 Nov 18;46(6):1290–9. doi:10.1111/coa.13832

21. Soyama S, Mano T, Kido A. Oropharyngeal dysphagia telerehabilitation in the Intensive Care Unit for COVID-19: a case report. Codas. 2022;34(6):e20210023. doi:10.1590/2317-1782/20212021023

22. Suntrup-Krueger S, Labeit B, Marian T, Schröder J, Claus I, Ahring S, et al. Pharyngeal electrical stimulation for postextubation dysphagia in acute stroke: a randomized controlled pilot trial. Crit Care. 2023 Oct 3;27(1):383. doi:10.1186/s13054-023-04665-6

23. Traugott M, Hoepler W, Kitzberger R, Pavlata S, Seitz T, Baumgartner S, et al. Successful treatment of intubation-induced severe neurogenic post-extubation dysphagia using pharyngeal electrical stimulation in a COVID-19 survivor: a case report. J Med Case Rep. 2021 Dec 22;15(1):148. doi:10.1186/s13256-021-02763-z

24. Turra GS, Schwartz IVD, Almeida ST de, Martinez CC, Bridi M, Barreto SSM. Efficacy of speech therapy in post-intubation patients with oropharyngeal dysphagia: a randomized controlled trial. Codas. 2021;33(2):e20190246. doi:10.1590/2317-1782/20202019246

25. Wu CP, Xu YJ, Wang TG, Ku SC, Chan DC, Lee JJ, et al. Effects of a swallowing and oral care intervention for patients following endotracheal extubation: a pre- and post-intervention study. Crit Care. 2019 Dec 9;23(1):350. doi:10.1186/s13054-019-2623-2

26. Algendy A, Bahgat Z. Effect of Oral Care Intervention and Safe-Swallowing Education on Dysphagia among ICU Patients Post Endotracheal Extubation. Tanta Sci Nurs J. 2021 Nov 1;23(4):11–35. doi:10.21608/tsnj.2021.210227

27. Siao SF, Ku SC, Tseng WH, Wei YC, Chang YC, Hsiao TY, et al. Effects of a swallowing and oral-care program on resuming oral feeding and reducing pneumonia in patients following endotracheal extubation: a randomized, open-label, controlled trial. Crit Care. 2023 Dec 1;27(1):283. doi:10.1186/S13054-023-04568-6

28. Hwang CH, Choi KH, Ko YS, Leem CM. Pre-emptive swallowing stimulation in long-term intubated patients. Clin Rehabil. 2007 Jan;21(1):41–6. doi:10.1177/0269215506071286

29. Bahia MM, Lowell SY. A Systematic Review of the Physiological Effects of the Effortful Swallow Maneuver in Adults With Normal and Disordered Swallowing. Am J Speech Lang Pathol. 2020 Aug 1;29(3):1655–73. doi:10.1044/2020_AJSLP-19-00132

30. Yang S, Park JW, Min K, Lee YS, Song YJ, Choi SH, et al. Clinical Practice Guidelines for Oropharyngeal Dysphagia. Ann Rehabil Med. 2023;47(Suppl 1):S1–26. doi:10.5535/ARM.23069

31. Speyer R, Cordier R, Sutt AL, Remijn L, Heijnen BJ, Balaguer M, et al. Behavioural Interventions in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analysis of Randomised Clinical Trials. J Clin Med. 2022 Feb 1;11(3):685. doi:10.3390/JCM11030685/S1

32. Rivelsrud MC, Hartelius L, Bergström L, Løvstad M, Speyer R. Prevalence of Oropharyngeal Dysphagia in Adults in Different Healthcare Settings: A Systematic Review and Meta-analyses. Dysphagia 2022 38:1. 2022 May 31;38(1):76–121. doi:10.1007/S00455-022-10465-X

33. Cohen DL, Roffe C, Beavan J, Blackett B, Fairfield CA, Hamdy S, et al. Post-stroke dysphagia: A review and design considerations for future trials. Int J Stroke. 2016;11(4):1747493016639057. doi:10.1177/1747493016639057

34. Oliveira I de J, Couto GR, Santos RV, Campolargo AM, Lima C, Ferreira PL. Best Practice Recommendations for Dysphagia Management in Stroke Patients: A Consensus from a Portuguese Expert Panel. Port J Public Health. 2021 Jan 25;39(3):145–62. doi:10.1159/000520505

35. Singer P, Blaser AR, Berger MM, Calder PC, Casaer M, Hiesmayr M, et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr. 2023 Sep 1;42(9):1671–89. doi:10.1016/J.CLNU.2023.07.011

36. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke. Stroke. 2019;50(12):e344–e418. doi:10.1161/STR.0000000000000211

37. Hou L, Li Y, Wang J, Wang Y, Wang J, Hu G, et al. Risk factors for post-extubation dysphagia in ICU: A systematic review and meta-analysis. Medicine (Baltimore). 2023 Mar 10;102(10):e33153. doi:10.1097/MD.0000000000033153

38. Zuercher P, Moser M, Waskowski J, Pfortmueller CA, Schefold JC. Dysphagia Post-Extubation Affects Long-Term Mortality in Mixed Adult ICU Patients-Data From a Large Prospective Observational Study With Systematic Dysphagia Screening. Crit Care Explor. 2022 Jun 8;4(6):E0714. doi:10.1097/CCE.0000000000000714

39. Tanaka K, Watanabe K, Kashiwagi H. Association between postextubation dysphagia and physical function in survivors of critical illness: A retrospective study. Clin Nutr ESPEN. 2022 Feb 1;47:147–51. doi:10.1016/j.clnesp.2021.12.031

40. Marian T, Dünser M, Citerio G, Koköfer A, Dziewas R. Are intensive care physicians aware of dysphagia? The MADICU survey results. Intensive Care Med. 2018 Jun;44(6):973-5. doi:10.1007/S00134-018-5181-1

41. Royals WJ, Gillis RJ, Campbell JL. A Decision Guide for Assessing the Recently Extubated Patient’s Readiness for Safe Oral Intake. Crit Care Nurse. 2023 Feb 1;43(1):42–51. doi:10.4037/CCN2023722

42. Mpouzika M, Iordanou S, Kyranou M, Iliopoulou K, Parissopoulos S, Kalafati M, et al. Strategies of Screening and Treating Post-Extubation Dysphagia: An Overview of the Situation in Greek-Cypriot ICUs. Healthcare 2023, Vol 11, Page 2283. 2023 Aug 13;11(16):2283. doi:10.3390/HEALTHCARE11162283

43. Freeman-Sanderson A, Hemsley B, Thompson K, Rogers KD, Knowles S, Hammond NE. Dysphagia in adult intensive care patients: Results of a prospective, multicentre binational point prevalence study. Aust Crit Care. 2023 Nov 1;36(6):961–6. doi:10.1016/j.aucc.2023.01.004

44. Likar R, Aroyo I, Bangert K, Degen B, Dziewas R, Galvan O, et al. Management of swallowing disorders in ICU patients - A multinational expert opinion. J Crit Care. 2024 Feb 1;79:154447. doi:10.1016/J.JCRC.2023.154447

45. Thibault R, Bear DE, Fischer A, Montejo-González JC, Hiesmayr M, Tamási P, et al. Implementation of the ESPEN guideline on clinical nutrition in the intensive care unit (ICU): It is time to move forward!: A position paper from the ‘nutrition in the ICU’ ESPEN special interest group. Clin Nutr ESPEN. 2023 Oct 1;57:318–30. doi:10.1016/j.clnesp.2023.06.033

46. Ordem dos Enfermeiros. Regulamento das competências específicas do enfermeiro especialista em Enfermagem de Reabilitação. Regulamento n.º 392/2019. Diário da República. 2019 May 3;2.ª série(85):13565–8. Available from: https://diariodarepublica.pt/dr/detalhe/regulamento/392-2019-122216893