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‘That’s terrible. The fact that you can’t communicate. You can open, close your mouth and know what you’re saying, knowing that nobody else can hear what it is that you’re trying to say.’ This was reported by a patient with a tracheostomy when he was seen on the ward after a 2 week stay on ICU.

‘It was a bit desperate wanting to have a drink. Food, not so much, but the drinking… You’re so thirsty it’s unbelievable.’ Another said this when interviewed after his stay in ICU.

Communication and swallowing disorders are what Speech and Language Therapists (SLTs) are trained to assess, diagnose and manage. The ability to communicate is fundamental to being human. Yet, many critical care units have no dedicated SLT support.

At University Hospitals Southampton, we were fortunate enough to have 0.7 sessions of SLT funded a year ago for General and Cardiac ICU, and at the Royal Berkshire Hospital 0.6 sessions of SLT are funded.

A typical day for SLT on ICU is varied and unpredictable. These are just some of the activities that we participate in and lead on:

• Early morning ward rounds
• Allied Health Professions and Pharmacy ward round
• Communication assessment and support. Trial of basic and low-tech communication aids, advising staff on simple strategies to support communication with patients who may be awake but intubated, delirious, confused and agitated or have non-invasive ventilation or a tracheostomy impeding their speech further
• Implementation of high-tech communication aids, such as eye gaze systems, for appropriate patients
• Liaising with the multidisciplinary team (MDT), carers and patients on care
• Swallow assessment. This may involve trialling strategies to enable safe eating or drinking or discussions around oral intake with accepted risk with the patient and MDT
• Instrumental swallow assessment such as videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to guide therapy and swallow rehabilitation
• Introduction of cuff deflation and speaking valve with tracheostomised patients
• Upper airway assessment with flexible nasendoscopy if the patient is dysphonic or to troubleshoot difficulties with tracheostomy weaning
• Joint assessments with nursing, occupational therapy and physiotherapy colleagues to facilitate weaning, swallowing and communication.

Follow-up is often required when they are stepped down to the ward with on-going support in the community if needed. Above all, SLTs provide an holistic, patient-focussed approach to patient management on ICU, and beyond. We can make a huge difference to this complex and vulnerable patient group, but we need the support of our critical care colleagues to open the doors for us and show you what we can do.

As we have started with the words of patients, it’s right to finish with their words also. This was written by a patient who was admitted to ICU with a basilar artery dissection during the pandemic:

‘One year ago you saved my life by showing me how to swallow again when I thought it was impossible. I will never forget that life-changing moment with you.’

Zoe Sherlock, Clinical Lead Speech & Language Therapist/Tracheostomy Practitioner (UHS FT)

Laura Adams, Highly Specialist Speech & Language Therapist Critical Care (UHS FT)

Charlie Macdonald, Speech & Language Therapist, ICU Lead (RBH)