Impaired Swallowing Function Research Articles

Tongue pressure values affect food form decisions in patients with impaired swallowing function

Tongue pressure values affect food form decisions in patients with impaired swallowing function

Graded nutritional interventions in patients with dysphagia after stroke: an assessment of the effectiveness of therapeutic strategies for different swallowing functions

Objective To evaluate the efficacy of graded nutrition intervention strategy in improving patients with different degrees of impaired swallowing function after stroke. Methods According to the way of nursing, the patients were divided into two group. The main outcome measure was Kota swallowing index (WSI) score, and the secondary outcome was complications during the intervention. SF-36 scale was used to evaluate the improvement of quality of life before and intervention. Results The WSI score in the control group was 62.34 ± 10.23 at 1 week after treatment, 70.52 ± 13.45 at 6 weeks after treatment, and 80.48 ± 9.87 at 12 weeks after treatment, while that in the intervention group was 71.45 ± 9.68 at 1 week after treatment, 75.81 ± 11.78 at 6 weeks after treatment, and 84.12 ± 14.32 at 12 weeks after treatment. The WSI scores of the intervention group were significantly higher than those of the control group (t = 5.634, p < 0.001), suggesting better swallowing function of the patients The incidence of pulmonary infection, malnutrition and gastroesophageal reflux in the intervention group was significantly lower than that in the control group (p < 0.05). There was no significant difference in throat inflammation and dehydration between the two groups (p > 0.05). In addition, graded nutrition interventions significantly improved patients’ quality of life, including dimensions of physical functioning, role physics, physical pain, and social functioning. Conclusion Compared with conventional treatment, personalized graded nutrition intervention can significantly improve the swallowing function and reduce the pulmonary infection rate in patients with swallowing disorders after stroke.

The influence of parenteral nutrition on the condition of the oral cavity: literature review.

Oral health plays a pivotal role in the overall well-being of patients. This article delves into the intricate interplay between oral health and systemic health outcomes in various patient populations, including those undergoing parenteral nutrition in childhood, individuals with impaired swallowing function, and those reliant on long-term enteral or parenteral nutrition. Through a comprehensive review of existing literature, the multifaceted role of oral health maintenance in optimizing nutritional therapy outcomes and enhancing overall quality of life is explored. Alternative forms of nutrition have a profound impact on Oral microbiota, which in turn is reflected in general health and wellbeing. Despite its significance, the importance of systematic oral health assessments and nurse involvement in providing holistic care to patients with complex medical needs has been underestimated. By elucidating critical connections between oral health and systemic health outcomes, this article aims to underscore the significance of oral health in comprehensive patient care and stimulate further research to advance our understanding of this crucial aspect of healthcare management.

Advantages of instant forms of antibiotics in the treatment of lower respiratory tract infections

Antibacterial drugs are the basis of pathogenetic therapy of most infectious diseases, including lower respiratory tract infections, which continue to occupy a leading place in the structure of morbidity and mortality from infectious diseases worldwide. At the same time, the continuing steady growth of antibiotic resistance of microorganisms, the problem of creating and developing new antibacterial drugs for use in outpatient practice determines the degree of importance of optimizing the dosage regimen of this group of drugs. According to domestic and foreign clinical recommendations, the drugs of choice for the treatment of lower respiratory tract infections in outpatient practice are aminopenicillins and inhibitor-protected penicillins. In the literature review of domestic and foreign studies, the advantages of instant forms of antibacterial drugs in the pharmacotherapy of lower respiratory tract infections are considered in detail and systematized. These include higher bioavailability of the drug, which provides an appropriate level of pharmacodynamic and clinical efficacy, a more favorable safety profile, ease of use in children and elderly patients, as well as in patients with impaired swallowing function, pharmacoeconomical advantages. Thus, the use of dispersible forms of antibacterial drugs in outpatient practice in the treatment of lower respiratory tract infections makes it possible to increase the effectiveness of pharmacotherapy, improve patient tolerance and adherence to treatment, which is especially important when taking medications independently, reduce treatment costs, which in combination helps to curb the development of antibiotic resistance.

Line Spread Test Results for Commercially Available the White Rice Porridge with Salted Plum - Including the Effect of Four Types of Thickening Agents Added after Blending

We added four commercially available thickeners to white rice porridge with salty plum, which is popular in Japan, and compared the viscosity. Porridge containing water is useful even in the event of a disaster. In Japan, porridge is useful as a stockpile of food during disasters. Porridge is used as a meal of a wide range of age groups, form the elderly to infants. However, if porridge is made into a liquid using a mixer, etc., it becomes a food with a high risk of aspiration for people with impaired swallowing function. Therefore, it is necessary to add a thickener to the liquid porridge to increase its viscosity. In order to keep the consistency, the thickening agent should be changed according to the amount of nutrients contained in the porridge.

Line Spread Test Results for Commercially Available the White Rice Porridge with Sticky Barley

In the event of a disaster, we will have to take stockpiled food. Retort porridge contains water and can be eaten directly from the container. However, there is a risk of aspiration for people with impaired swallowing function. As a result of the line spread test (LST), which was performed after homogenizing white rice porridge with sticky barley using a mixer, it was found that the viscosity was weak, and there was a risk of aspiration for people with weakened swallowing function. The thickness was added to white rice porridge with sticky barley by using four types of commercially available thickening agents that was made into a uniform liquid with a mixer. A line spread test (LST) was performed by adding 2 g of each thickening agent to 100g of liquid porridge. As a result, the viscosity of the liquid porridge was stabilized and thickened, and it became a state that could swallow more safely. In the line spread test, the thickness of the porridge was measured after 30 seconds, 5 minutes, 15 minutes, and 30 minutes.

Line Spread Test Results for Commercially Available the White Rice Porridge with Salmon

Commercially available porridge containing ingredients (meat, fish, vegetables, etc.) has a high nutritional value and is very useful both daily and in the event of a disaster. By making porridge into a uniform liquid porridge with a mixer, baby food and people with weak chewing ability can eat it. Uniform liquid porridge poses a risk of aspiration for people with impaired swallowing function. In this study, we report the result of making the white rice porridge with salmon into a uniform liquid porridge with a mixer and adding four different types of Thickener to increase the viscosity. By adding salmon as an ingredient, the amount of protein was higher than that of white rice porridge. By adding two types of Thickener containing dextrin and calcium lactate, the viscosity remained stable over time. The type of thickening agent that stabilizes the viscosity varies depending on the nutrients contained in the porridge, we would like to study more combinations of porridge and thickening agents in the future.

Antisialogogue Effect of Atropine Sulfate at Dosages of 0.25 Mg and 0.5 Mg Under General Anesthesia with Ketamin

Introduction: Excessive saliva production can becomes an airway problem in conditions of decreased consciousness where there is impaired swallowing function. It increases the risk of aspiration of saliva into the airways that can result in choking. The use of premedication drugs to reduce the incidence of drug-induced hypersalivation can be done as a prevention. The anticholinergic drug class is the drug of choice for the management of hypersalivation in general anesthesia patients who have been given ketamine and ether. Ketamine as a sedating agent will provide a side effect of hypersalivation, where hypersalivation can cause laryngospasm or aspiration, as a form of prevention, anticholinergic drugs such as atropine can be given. The aim of this research was to compare the effect of antisialagogue on the administration of atropine sulfate at a dose of 0.25 mg and 0.5 mg in intravenous general anesthesia patients without ETT with ketamine at Haji Adam Malik General Hospital Medan and Putri Hijau Hospital Medan. Method: This study used a double blind RCT design. A total of 60 patients with intravenous general anesthesia without ETT with ketamine (1-2 mg/kg BW) were divided into 2 groups of Atropine Sulfas doses (0.25 and 0.5 mg) then the total salivary volume of each patient was measured and analyzed. Results: There was a significant difference between the treatment groups of 0.25 mg and 0.5 mg in the volume of saliva that had been collected (P-value = 0.008). Conclusion: There was a significant comparison between the use of 0.25 mg and 0.5 mg atropine in patients at Haji Adam Malik Hospital and Putri Hijau Hospital Medan.

Malnutrition, nutrition support and dietary intervention: the role of the dietitian supporting patients with head and neck cancer

Malnutrition is prevalent in patients with head and neck cancer (HNC) at diagnosis but can occur at any stage of the treatment pathway. The impact of disease burden and treatment side effects can lead to altered anatomy, compromised quality and quantity of saliva and impaired swallowing function, which can result in deleterious effects on nutritional status. Optimising nutrition status is critical, as malnutrition is adversely associated with treatment tolerance and outcomes, wound healing, morbidity, mortality, quality of life and survival. Dietitians are integral members of the HNC multidisciplinary team and are uniquely qualified in the assessment, management and optimisation of nutritional status across the care pathway. This includes providing informational counselling to patients and carers on the short- and long-term nutritional impact of planned treatments alongside multidisciplinary members. Dietitians lead on the recommendation, provision and monitoring of nutrition support, which can be via the oral, enteral or parenteral route. Oral nutrition support includes dietary counselling, nourishing dietary, food fortification advice and high energy/protein oral nutritional supplements. Enteral nutrition support, or tube feeding, can be required on a short- and/or long-term basis and dietitians support appropriate decision-making for the type of tube and timing of placement across the care pathway.

Biomechanical mechanism of reduced aspiration by the Passy-Muir valve in tracheostomized patients following acquired brain injury: Evidences from subglottic pressure.

Aspiration is a common complication after tracheostomy in patients with acquired brain injury (ABI), resulting from impaired swallowing function, and which may lead to aspiration pneumonia. The Passy-Muir Tracheostomy and Ventilator Swallowing and Speaking Valve (PMV) has been used to enable voice and reduce aspiration; however, its mechanism is unclear. This study aimed to investigate the mechanisms underlying the beneficial effects of PMV intervention on the prevention of aspiration. A randomized, single-blinded, controlled study was designed in which 20 tracheostomized patients with aspiration following ABI were recruited and randomized into the PMV intervention and non-PMV intervention groups. Before and after the intervention, swallowing biomechanical characteristics were examined using video fluoroscopic swallowing study (VFSS) and high-resolution manometry (HRM). A three-dimensional (3D) upper airway anatomical reconstruction was made based on computed tomography scan data, followed by computational fluid dynamics (CFD) simulation analysis to detect subglottic pressure. The results showed that compared with the non-PMV intervention group, the velopharynx maximal pressure (VP-Max) and upper esophageal sphincter relaxation duration (UES-RD) increased significantly (P < 0.05), while the Penetration-Aspiration Scale (PAS) score decreased in the PMV intervention group (P < 0.05). Additionally, the subglottic pressure was successfully detected by CFD simulation analysis, and increased significantly after 2 weeks in the PMV intervention group compared to the non-PMV intervention group (P < 0.001), indicating that the subglottic pressure could be remodeled through PMV intervention. Our findings demonstrated that PMV could improve VP-Max, UES-RD, and reduce aspiration in tracheostomized patients, and the putative mechanism may involve the subglottic pressure. [http://www.chictr.org.cn], identifier [ChiCTR1800018686].

Swallowing function after acute ischemic stroke: Development and validation of a novel clinical prognostic model.

BackgroundPredicting the duration of dysphagia after acute ischemic stroke (AIS) is important for clinical treatment decisions.ObjectiveThe purpose of this study is to assess the swallowing function of AIS patients and to develop and validate a prognostic model for the need for nasogastric tube (NGT) in these patients.Materials and methodsWe included 554 AIS patients during 2018–2019 as the development group and had 186 AIS patients as the external validation group. The primary end point of the study was the retention of NGT in patients 1 week after admission (Functional Oral Intake Scale ≤ 4). Swallowing function and stroke-associated pneumonia (SAP) at 1 month post-onset were also the objectives of this study. The volume-viscosity swallow test (V-VST) was used to assess the patient’s impaired swallowing function. The Predictive model was built by logistic regression.ResultsOverall, a total of 104 patients required indwelling NGT at 1 week of AIS onset in development group. The final prognostic model includes 5 variables: age (OR: 1.085, 95%CI: 1.049–1.123), neutrophil-to-lymphocyte ratio (NLR) (OR: 1.332, 95%CI: 1.090–1.626), NIHSS (OR: 1.092, 95%CI: 1.025–1.164), history of drinking (OR: 2.532, 95%CI: 1.452–4.417) and stroke location (Subtentorial vs. Supratentorial, OR: 1.954, 95%CI: 1.088–3.509). The prediction model had an AUC of 0.810, while the external validation group was 0.794.ConclusionIn stroke patients, it is very important to decide early whether to indwell a NGT. The nomogram will support decision making for NGT insertion and help these patients recover from their condition.

Pilot Study of Respiratory-Swallow Coordination in Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis (ALS) impacts bulbar and respiratory musculature, which may contribute to impaired swallow function (dysphagia) and respiratory-swallow coordination. The purpose of this pilot study was to examine if respiratory-swallow coordination in individuals with ALS was perturbed compared to healthy controls. We further explored relationships between measures of respiratory function and self-reported swallowing outcomes on respiratory-swallow coordination. We employed a cross-sectional design with eight participants with ALS and eight age- and sex-matched healthy participants. Respiratory inductance plethysmography and a nasal cannula were used to capture respiratory-swallow phase patterns during a standardized clinical swallow examination. The advantageous respiratory-swallow phase pattern was defined if exhalation surrounded the swallow (E-E). Spirometry was used to capture indices of respiratory function (forced vital capacity % predicted, peak cough flow [PCF]). Validated questionnaires were used to collect information regarding ALS-related bulbar functional status and swallowing-related concerns. Compared to the matched healthy cohort, individuals with ALS demonstrated higher rates of non-E-E respiratory-swallow phase patterning and worse bulbar/swallow dysfunction. Group (ALS), swallow tasks, and PCF were significantly associated with respiratory-swallow phase pattern. These preliminary findings support altered respiratory-swallow phase patterning in ALS. Future work should employ an instrumental assessment to quantify swallowing physiology and elucidate the relationship between perturbed respiratory-swallow coordination and swallowing function.

Perspectives on speech and language pathology practices and service provision in adult critical care settings in Ireland and international settings: A cross-sectional survey

Purpose Patients admitted to critical care (CC) are at risk of impaired swallowing and communication function. Speech-language pathologists (SLPs) play an important role in this context. In Ireland and internationally speech-language pathology CC guidelines are lacking, with possible variations in practice. To compare clinical practices in dysphagia, communication and tracheostomy management among SLPs working in adult CC units in Ireland and internationally, and explore their perspectives on training, skills and resources. Method Participants were SLPs working in CC. An international online survey sought information on (i) SLP workforce demographics and staffing levels, (ii) current dysphagia and communication assessment and management practices, (iii) practices and perspectives on training, skills and resources. Result 366 responses were received across 29 countries. 18.03% (66/366) of these respondents worked in Ireland. Findings showed similarities and differences in practices. Total CC SLP whole-time equivalent (WTE) at each staff grade was lower (mean difference: −0.21 to −0.65 WTE p <.001) than desired for optimal service delivery. Negative effects of under-staffing were reported. Recommendations that all tracheostomised patients receive SLP input was unmet in 66% (220/334) of services. Conclusion SLP input in CC is limited in terms of dedicated posts, multidisciplinary team (MDT) involvement, consistent management approaches and training opportunities internationally. Implications of findings are discussed.

The influence of edema on the bisoprolol blood concentration after bisoprolol dermal patch application: A case-control study.

Background:Beta-blocking is important for critically ill patients. Although some patients are required to continue taking beta-blockers after they no longer need critical care, some of these patients have impaired swallowing abilities. Bisoprolol dermal patches have recently been introduced and appear to be a good alternative to oral bisoprolol tablets. However, it is still unclear whether the pharmacodynamics of such patches are affected by edema in patients who have experienced critical care. This study aimed to clarify the effects of systemic edema on beta-blocker absorption from dermal patches in critically ill patients.Method:Patients who exhibited tachycardia and impaired swallowing function after critical care were included in this study. They were assigned to either the edema group (n = 6) or no edema group (n = 6) depending on the presence/absence of edema in the lower extremities. A bisoprolol dermal patch was pasted onto each subject, and the blood bisoprolol concentration was checked at 8 timepoints over the next 24 hours. The area under the serum concentration time curve, maximum concentration observed (Cmax), and time of maximum concentration observed were also examined.Result:The mean blood bisoprolol concentrations of the 2 groups were not significantly different at 2, 4, 6, 8, 10, 12, 16, or 24 hours after the patch application. The area under the serum concentration time curve and maximum concentration observed were not different between the groups. The mean heart rates of the 2 groups were not significantly different at 6, 12, or 24 hours after the patch application (Student t test, P = .0588, P = .1080, and P = .2322, respectively).Conclusion:In this study, the blood concentration of bisoprolol and its heart rate-reducing effects after bisoprolol dermal patch application might not be affected by systemic edema in the lower extremities.

THE NEW STIMULATING METHOD IN THE SPEECH THERAPY WORKOUT SYSTEM FOR THE RESTORATION OF THE SWALLOWING FUNCTION IN SEVERE BRAIN INJURIES

Background. The significance of this study becomes more relevant due to the higher incidence and complication of dysphagia in patients with severe brain damage as a result of stroke, traumatic brain injury, and other diseases and injuries. Purpose The study aimed to assess the effectiveness of the new stimulating method - "passive-active logopedic cryomassage" for restoring impaired swallowing function (dysphagia) in patients with severe brain injury, used in the system of speech therapy measures at the early stage of rehabilitation in the neurointensive care unit. Methods. The study involved 96 patients with dysphagia caused by severe brain damage, who received speech therapy assistance aimed at restoring the impaired swallowing function in a system of early rehabilitation measures carried out in a neurorehabilitation department. The severity of dysphagia was evaluated using an integrative assessment of swallowing function scale. Results. The practice of using the new method developed in combination with thermal and tactile stimulation: "passive-active logopedic cryomassage" indicated its higher efficiency in comparison with the traditionally used methods of speech therapy stimulation. In the course of this study, there were three categories of patients: patients with a rapid positive effect, patients with a delayed effect, and patients with no apparent positive effects. There was an analysis of all possible causes of different therapeutic effects. Conclusion. This new method of combined thermal and tactile stimulation - "passive-active logopedic cryomassage" can be recommended with all its indications and contraindications for widespread use in the clinical practice assisting speech therapists in the restoration of impaired swallowing function in patients with severe brain injury

Are there any differences between the tongue and posterior pharyngeal wall movement patterns during normal and Masako swallow?—An ultrasound analysis

Parkinson's disease (PD) is a neurodegenerative movement disorder affecting volitional movement due to Dopamine-producing neuron death in the substantia nigra. Impaired swallow function is highly prevalent with nearly 100% involvement in PD during the disease course and involves all three phases of swallowing. The oral stage of swallowing is impaired first. Reduced bolus control and reduced interior-to-posterior movement of the bolus transfer lead to delayed swallowing response, premature spillage, decreased base of tongue (BOT) retraction and strength, decreased hyolaryngeal elevation and excursion, and reduced action of pharyngeal constrictors. Together, these result in bolus retention, residue throughout the pharynx, and reduced airway protection leading to significant aspiration. To target these deficits we have designed an exercise regime to teach early to mid-stage PD patients to do the Masako swallow maneuver of saliva (swallow with tongue-tip held between teeth), with high intensity and frequency (i.e., 120 repetitions per day) in one month. The preliminary results are very promising. All participants demonstrated positive changes. To understand the underlying mechanism, we used Ultrasound and recorded 20 normal subjects while they did three normal swallows and 3 Masako swallow maneuvers. The initial observations indicated the tongue and pharyngeal movement patterns differ between the two maneuvers.

Research on the Combination of Commercially Available Thickeners and Commercially Available Nursing Food - Universal Design Food: UDF (can be Crushed with Gums)

In Japan, a super-aging society, there is much debate about how to provide safe home care in the future. To provide safe nursing care food, it is necessary to consider not only the nutritional aspect of the diet but also the dietary form. In the case of diminished or impaired swallowing function, it is useful that the viscosity of the diet matches the ability of the care recipient to swallow the food. Therefore, in this study, we report the viscosity measurement using a commercially available thickener and a commercially available universal design food (which can crush with gums) by changing the blending amount and combination of them. In this study, we used commercially available thickener A, and thickener B, which can purchase at pharmacies and three types of commercially available universal design foods (which can crush with gums) can purchase at pharmacies. In the case of foods having a large amounts of carbohydrates, the thickener B (high in thickening polysaccharides) can stabilize the viscosity and is suitable for adjusting the viscosity.

Analysis of clinical outcomes in elderly patients with impaired swallowing function.

Japan is the world's leading aging society, and increasing medical expenses for elderly people is an urgent issue. Since aspiration pneumonia in elderly people with impaired swallowing function is a huge problem in Japan, their expected long-term clinical course should be clarified. Accordingly, we collected data from 991 elderly (≥75 years old) patients whose swallowing function was evaluated by Kitasato Institute Hospital's speech therapists (January 1, 2010 to December 31, 2017). We analyzed the relationship between swallowing function and the subjects' long-term prognosis. To clarify the prognostic factors of patients with dysphagia, we obtained their clinical information (age, gender, activities of daily living, nutritional status, availability of alternative feeding pathways such as percutaneous endoscopic gastrostomy, and cognitive function). We confirmed 372 death cases and stratified the cases into three groups using Fujishima's swallowing ability grade, which is used to predict elderly people's real-world life expectancy. Results showed the median survival days were 331 and 952 days in Groups I (Grades 1-3, n = 308) and II (Grades 4-6, n = 153), respectively, whereas the median survival days for Group III (Grades 7-10, n = 530) could not be calculated. We conducted a multivariate analysis using the Cox proportional hazards model with Group I, which revealed that initial grade and percutaneous endoscopic gastrostomy were significant prognostic factors for the subjects' long-term survival. Nevertheless, further discussion is necessary, particularly to determine advanced care planning regarding indications for alternative feeding pathways in elderly patients with severe dysphagia, since percutaneous endoscopic gastrostomy could significantly prolong their survival.

Pre- and Post-Surgical Dysphagia in Adults with Tumors of the Posterior Fossa: A Prospective Blinded Study.

Simple SummaryDysphagia is a known complication of posterior fossa tumor resection, but data regarding risk factors and clinical course are sparse, in particular in adults. The purpose of this study was to investigate frequency, severity and outcome of swallowing disorders in adults undergoing PFT-surgery to improve presurgical counseling and postsurgical therapeutic care. Our findings demonstrate that dysphagia is a frequent finding before and after surgery putting patients at risk for aspiration and pneumonia. We provide clinical predictors which might be helpful in identifying dysphagic patients in order to determine the safest feeding route. This might lead to both improvement of outcome and reduction of medical complication.Background: While swallowing disorders are frequent sequela following posterior fossa tumor (PFT) surgery in children, data on dysphagia frequency, severity, and outcome in adults are lacking. The aim of this study was to investigate dysphagia before and after surgical removal of PFT. Additionally, we tried to identify clinical predictors for postsurgical swallowing disorders. Furthermore, this study explored the three-month outcome of dysphagic patients. Methods: In a cohort of patients undergoing PFT surgery, dysphagia was prospectively assessed pre- and postoperatively using fiberoptic endoscopic evaluation of swallowing. Patients with severe dysphagia at discharge were re-evaluated after three months. Additionally, clinical and imaging data were collected to identify predictors for post-surgical dysphagia. Results: We included 26 patients of whom 15 had pre-operative swallowing disorders. After surgery, worsening of pre-existing dysphagia could be noticed in 7 patients whereas improvement was observed in 2 and full recovery in 3 subjects. New-onset dysphagia after surgery occurred in a minority of 3 cases. Postoperatively, 47% of dysphagic patients required nasogastric tube feeding. Re-evaluation after three months of follow-up revealed that all dysphagic patients had returned to full oral intake. Conclusion: Dysphagia is a frequent finding in patients with PFT already before surgery. Surgical intervention can infer a deterioration of impaired swallowing function placing affected patients at temporary risk for aspiration. In contrast, surgery can also accomplish beneficial results resulting in both improvement and full recovery. Overall, our findings show the need of early dysphagia assessment to define the safest feeding route for the patient.

The speech pathology workforce in intensive care units: Results from a national survey

BackgroundAdmission to the intensive care unit (ICU) with mechanical ventilation can lead to patients experiencing impaired swallowing and communication function. This can negatively affect patient experiences and outcomes. There is increasing research supporting early intervention for swallowing and communication; however, there are no published ICU workforce data to determine patient access. PurposeThe purpose of this study was to describe national ICU access to speech pathology (SP) services and to describe the nature of this workforce. MethodsProspective audit of Australian ICUs with a focussed workforce survey of SP service including workforce demographics, clinical practices, team environments, and training was conducted. Data are described as percentage (%, n) and as median (interquartile range). Qualitative data were analysed using thematic frameworks. ResultsSP services were available at 99% (n = 165) of the sites; 62 sites provided workforce data (45% response rate). Seventy-one percent of respondents serviced the ICU ≤10 h per week, with 23% reporting dedicated funding. Almost a third (32%) reported not participating in ICU team activities, and more than half of the sites (56%) did not provide ICU-specific training with resulting varied clinical confidence ratings. Facilitator and barriers both highlighted team working relationships. Facilitator themes were building working relationships, understanding the SP role in the multidisciplinary team, physical presence in the unit, and access to resources. Barrier themes were the multidisciplinary team's understanding of SP roles and lack of presence of SP services in the ICU. ConclusionsSP services are not standard across Australian ICUs, with variations in confidence, funding, training, and team environments. Further research into the impact of these variations on patient outcomes is needed.