Treating Dysphagia in Cardiac Surgery Patients: A Guide for SLPs

As speech-language pathologists, we play an essential role in the multidisciplinary care team for patients undergoing cardiac surgery. Managing dysphagia in this patient population requires that we understand cardiac surgical procedures and how they can affect swallowing function.

In this article, we’ll take a look at the relationship between cardiac surgery and dysphagia, along with strategies that SLPs can use to effectively identify, assess, and intervene when cardiac patients develop difficulty swallowing.

Understanding the Connection Between Cardiac Surgery and Dysphagia

Cardiac surgery, which is focused on restoring heart health, can inadvertently affect the swallowing mechanism. This is due to factors such as the physical trauma from intubation, prolonged use of mechanical ventilation, and potential nerve damage. Moreover, the physiological stress from surgery and sedation can further exacerbate or make apparent any underlying swallowing difficulties. Recognizing these risks is the first step in proactive management of dysphagia in cardiac patients.

Preoperative Screening: The First Line of Defense

Preoperative dysphagia screening is an important preventative measure. Tools like the Yale Swallow Protocol help identify at-risk patients before they undergo surgery. However, the unique challenge in cardiac surgery cases is the balancing act between urgent cardiac needs and potential dysphagia risks. Therefore, SLPs must advocate for and execute timely and efficient screening processes to flag any pre-existing swallowing concerns or predict potential postoperative complications.

Navigating Postoperative Dysphagia Management

Best practices for managing and treating dysphagia after cardiac surgery include:

• Early identification and assessment: Close monitoring for signs of dysphagia immediately after surgery is crucial. The use of standardized screening tools post-extubation can aid in early detection, guiding the need for comprehensive swallowing evaluations.
• Tailored rehabilitation plans: Given the varied impacts of cardiac surgery on swallowing, rehabilitation plans should be highly individualized. This might include exercises to strengthen swallowing muscles, strategies to enhance safe swallowing, and dietary modifications, all tailored to the patient’s specific needs and recovery trajectory.
• Interdisciplinary collaboration: Effective dysphagia management requires seamless collaboration with the broader medical team. SLPs should work closely with dietitians, nurses, physical therapists (PTs), occupational therapists (OTs), respiratory therapists (RTs), and physicians to align on care plans, ensuring that swallowing interventions complement overall patient recovery goals.
• Staying informed on cardiac procedures: Understanding the types of cardiac surgeries and their potential impacts on swallowing can inform more precise assessments and interventions.
• Embracing technology: Utilize available technology, such as videofluoroscopic swallow studies (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES), to obtain detailed insights into the patient’s swallowing mechanics and tailor interventions accordingly.
• Educating and supporting: Beyond direct patient care, SLPs should educate patients and their families about dysphagia risks and management strategies, empowering them to be active participants in the recovery process.

For SLPs working with cardiac surgery patients, effective dysphagia management includes early detection, interdisciplinary collaboration, and tailored rehabilitation approaches. By leveraging our expertise in swallowing disorders, we can significantly contribute to the comprehensive care of these patients, enhancing their recovery and quality of life post-surgery. Continued education, research, and dialogue within our profession and with other healthcare disciplines are vital to advancing our practice in this important area.