SLPs in Critical Care: Building Expertise and Driving Patient Outcomes

The intensive care unit (ICU) is where speech-language pathologists encounter some of the most complex and high-stakes cases. Working with critically ill patients requires not only expertise in swallowing and communication but also the ability to navigate an environment filled with life-altering decisions and constant collaboration. To make a meaningful impact, you need advanced clinical skills, adaptability, and a commitment to speech-language pathology continuing education.

A significant concern in this setting is the high incidence of dysphagia among ICU patients, particularly following intubation or tracheostomy. Approximately 40 to 50 percent of patients who are intubated in ICUs experience dysphagia after extubation,¹ and approximately one-third of those aspirate, increasing their risk of aspiration pneumonia and other complications.² This highlights just how critical your interventions are in reducing these risks, improving patient recovery, and facilitating smoother transitions to subsequent levels of care.

In this article, we provide actionable insights and strategies to help you thrive in the ICU, whether you’re building confidence as a new clinician or refining your skills to stay at the forefront of your field.

The unique demands of critical care

The challenges you face in the ICU are unlike any other setting. The high-stakes environment requires you to work alongside intensivists, nurses, respiratory therapists, and other professionals in real-time to address life-altering decisions. For SLPs, this often means stepping into a sea of monitors, ventilators, and medical equipment while staying focused on the person behind the diagnosis.

Your expertise as an SLP is frequently sought for dysphagia management, cognitive evaluations, and communication facilitation. However, your role extends far beyond these tasks. You serve as the bridge between patients, families, and the rest of the care team, ensuring that communication flows seamlessly in the most challenging circumstances.

Thriving in this dynamic space requires you to tap into your adaptability, emotional resilience, and dedication to advancing your skills through education and mentorship. Investing in these areas makes you an indispensable advocate for your patients’ recovery and quality of life.

4 core competencies for SLPs in critical care

1. Your knowledge of critical care practices

2. Your collaborative skills

3. Your focus on patient-centered care

4. Your commitment to continuous learning and self-awareness

When you work in the ICU, every decision you make can have far-reaching effects on your patients’ recovery. These four core competencies will help you navigate the complexities of critical care and build trust within the multidisciplinary team. Let’s take a closer look at the detailed competencies below to see how you can strengthen your skills and advance your practice.

1. Knowledge of critical care practices

Familiarity with the ICU’s intricate ecosystem is essential. As an SLP, you’ll encounter advanced medical technologies, such as ventilators and tracheostomy systems, directly impacting swallowing and communication. To confidently support your patients, you need a deep understanding of how these devices and procedures influence their care.

Instead of relying solely on your foundational SLP training, consider accessing respiratory care journals, attending interdisciplinary workshops, and engaging in hands-on learning opportunities. These resources can expand your ability to evaluate patients within the ICU context effectively.

For example, evidence-based interventions like using speaking valves for ventilated patients facilitate verbal communication and enhance swallowing function. By staying informed on these developments, you’ll strengthen your ability to deliver meaningful care and become a valued contributor to the ICU team.

2. Collaborative skills

Trust and teamwork are at the heart of patient care in the ICU. Engaging with nurses, respiratory therapists, dietitians, and other professionals is essential to aligning your interventions with the patient’s care plan. By showcasing your expertise and a collaborative mindset, you build rapport and establish yourself as a vital member of the team.

From our experiences, the key to fostering trust is clear communication and showing that you understand the pressures your colleagues face. For example, when a nurse is managing multiple critical tasks, offering a brief, targeted explanation of your plan can help them see the immediate value of your work.

Shadowing team members from other disciplines is also valuable. For example, observing a respiratory therapist’s approach to ventilator settings can give you insights that directly inform how and when to proceed with swallowing or communication interventions. This collaborative learning deepens your understanding of the ICU environment and ensures your contributions are impactful.

3. Patient-centered care

The ICU is often where patients face their most vulnerable moments. Your ability to connect with them and their families can transform how they experience care, even when communication barriers seem impossible. Nearly 24 percent of ICU patients report significant emotional distress when unable to communicate effectively, often leading them to abandon attempts altogether.³ You might create augmentative and alternative communication (AAC) tools, like a personalized eye-gaze board or a simple picture board, allowing them to express critical needs and preferences.

Helping families and patients express their goals and preferences fosters autonomy and ensures their voices are part of the decision-making process. Both patients and providers agree that these tools not only alleviate frustration but also restore a sense of dignity and control in an otherwise overwhelming environment​​.

4. Continuous learning and self-awareness

Working in critical care requires a commitment to lifelong learning and personal growth. You need to recognize your knowledge gaps, seek mentorship, and take ownership of your independent study. For example, the PADIS guidelines emphasize the importance of addressing key factors like pain, agitation/sedation, delirium, immobility, and sleep disruption when caring for critically ill patients.⁴ These interconnected issues often directly impact communication and swallowing, making it essential for you to stay informed about evidence-based practices and multidisciplinary approaches to care. Exploring these guidelines can improve your ability to foresee complications and work collaboratively with the ICU team.

Reflecting on your experiences and learning from mistakes is also crucial for your professional growth. You’ll inevitably face situations where you feel unprepared, and those moments can teach you the most. It’s important to be honest about your limitations and ask questions when needed. Seeking input from colleagues or mentors is not a sign of weakness—it demonstrates your commitment to providing the best possible care for your patients and helps build trust within the ICU team.

Every interaction with a patient or team member is an opportunity to grow. Take time to debrief after challenging cases, discuss alternative strategies, and embrace constructive feedback. These moments of reflection will sharpen your skills and help you approach your next case with greater confidence and insight.

Demonstrating value in the ICU

To establish yourself as an integral part of the ICU team, it’s critical to demonstrate how your work directly benefits patients and the broader care team. Your contributions extend well beyond immediate swallowing or communication interventions, influencing outcomes like recovery timelines, patient autonomy, and overall care quality. Highlighting these impacts helps reinforce the importance of speech-language pathology in critical care.

Here are key areas where your expertise can make a measurable difference:

• Restoring patient autonomy: Implementing communication strategies, such as AAC tools or speaking valves, allows patients to express preferences and regain control during a vulnerable time.

• Reducing medical complications: Early swallowing interventions can lower the risk of aspiration pneumonia and other complications that prolong ICU stays.

• Enhancing discharge planning: Conducting thorough cognitive and communication assessments equips the team with the information needed for smoother transitions to the next level of care.

• Improving team communication: By acting as a bridge between the patient, family, and care team, you ensure that everyone is aligned on the patient’s goals and needs, reducing misunderstandings and delays in care.

• Fostering emotional connection: Your interventions often provide emotional relief to patients and families, as they feel heard and involved in the decision-making process.

Building skills for lifelong impact in the ICU

Navigating the ICU requires a distinct combination of expertise and adaptability, making your role as an SLP invaluable in this high-stakes environment. From addressing complex swallowing and communication needs to fostering collaboration with multidisciplinary teams, your work profoundly influences patient outcomes and team effectiveness. By continually honing your skills and embracing opportunities for growth, you cement your role as a vital member of the critical care team.

Take the next step in advancing your practice—expand your clinical expertise with our comprehensive four-part course series. Designed to enhance your skills and confidence in critical care settings, this series provides actionable insights into ICU care models, strategies for implementing SLP services, and techniques for demonstrating your value within a multidisciplinary team.

Each course builds on the previous one, guiding you through a structured learning experience that deepens your understanding of SLP management in critical care:

• Behind the Scenes With SLPs Across Models of Care in the ICU

• PARTNERS: Inclusive Framework for Multidisciplinary Team Conversations

• Assessment of Swallowing in the ICU: Where Do You Start?

• Swallowing Treatment: What's Next?

By the final course, you'll have a well-rounded grasp of key concepts essential for providing effective patient care in critical care settings. Advance your practice, strengthen your impact, and elevate patient care in the ICU.

References

1. Brodsky, M. B., Levy, M. J., Jedlanek, E., Pandian, V., Blackford, B., Price, C., Cole, G., Hillel, A. T., Best, S. R., & Akst, L. M. (2018). Laryngeal injury and upper airway symptoms after oral endotracheal intubation with mechanical ventilation during critical care: A systematic review. Critical Care Medicine, 46(12), 2010-2017. https://doi.org/10.1097/CCM.0000000000003368

2. McIntyre, M., Doeltgen, S., Dalton, N., Koppa, M., & Chimunda, T. (2021). Post-extubation dysphagia incidence in critically ill patients: A systematic review and meta-analysis. Australian Critical Care, 34(1), 67-75. https://doi.org/10.1016/j.aucc.2020.05.008

3. Cheng, Cheng; Schommer, Lana; Tarver, Micheal; LaValley, Mimi; Lemieux, Nina; Mery, Marissa; et al. (2024). AAC in ICU survey study (Cheng et al., 2024). ASHA journals. Online resource. https://doi.org/10.23641/asha.26339623.v1

4. Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande, P. P., ... & Alhazzani, W. (2018). Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine, 46(9), e825-e873. https://doi.org/10.1097/CCM.0000000000003299