Scope and Scan Led Airway Care: Therapist Laryngeal Visualization.

Abstract

Dysphagia and impaired vocal fold motion are common complications following endotracheal intubation in critically ill patients and are associated with adverse clinical outcomes. In the ICU setting, laryngeal dysfunction complicates core physiotherapy and respiratory therapy tasks, including noninvasive therapies, cough evaluation, and airway clearance. This clinically oriented narrative synthesis outlines how bedside visualization with transnasal fiberoptic laryngoscopy (TFL) and translaryngeal ultrasound (TLU) can improve individualized airway clearance strategies and optimization of noninvasive ventilation when laryngeal dysfunction is suspected. Both modalities enable direct assessment of secretion pooling, penetration and aspiration, cough function, and mucosal trauma. In difficult cases, TFL can confirm that a nasotracheal suction catheter has traversed the vocal folds when blind nasotracheal attempts fail, facilitating an effective cough. Within interprofessional workflows, TLU can serve as an accessible screening tool, whereas targeted TFL-supported assessments add diagnostic and therapeutic value in challenging cases. Safe implementation, particularly of TFL, requires appropriate skills, adherence to infection-prevention protocols, and structured local training and credentialing. Existing clinician-performed ultrasound frameworks may be adapted to support competence in TLU. Embedding these modalities into credentialed and audited clinical pathways may enhance safety and efficiency, although pragmatic implementation and outcome studies remain key priorities.