Scope and Scan Led Airway Care: Therapist Laryngeal Visualization

Area of Science:

• Critical Care Medicine
• Pulmonology
• Otolaryngology

Background:

• Laryngeal dysfunction, including dysphagia and vocal fold impairment, is a frequent complication of endotracheal intubation in intensive care unit (ICU) patients.
• This dysfunction complicates essential respiratory and physiotherapy interventions such as airway clearance and noninvasive ventilation.
• Adverse clinical outcomes are associated with post-intubation laryngeal dysfunction.

Purpose of the Study:

• To outline how bedside visualization techniques can enhance airway clearance strategies and optimize noninvasive ventilation in patients with suspected laryngeal dysfunction.
• To describe the utility of transnasal fiberoptic laryngoscopy (TFL) and translaryngeal ultrasound (TLU) in managing ICU patients.

Main Methods:

• This narrative synthesis reviews the application of TFL and TLU for bedside laryngeal assessment.
• Both modalities allow direct visualization of secretion pooling, penetration, aspiration, cough effectiveness, and mucosal trauma.
• TLU is presented as a screening tool, while TFL offers detailed diagnostic and therapeutic value, especially in complex cases.

Main Results:

• TFL and TLU enable direct assessment of laryngeal function, aiding in secretion management and cough evaluation.
• TFL can confirm catheter passage through the vocal folds, facilitating effective suctioning in challenging cases.
• TLU serves as an accessible screening tool, complementing TFL for comprehensive laryngeal assessment.

Conclusions:

• Bedside TFL and TLU can significantly improve individualized airway clearance and noninvasive ventilation strategies for ICU patients with laryngeal dysfunction.
• Safe implementation requires skilled practitioners, adherence to infection control, and structured training programs.
• Further pragmatic implementation and outcome studies are necessary to fully integrate these modalities into clinical pathways.