The collaboration of RTs and SLPs in German centers for weaning from mechanical ventilation in neurological and neurosurgical early rehabilitation - results from an online survey.

Background: Weaning in early neurological-neurosurgical rehabilitation (ENNR) is an interdisciplinary process performed by physician-led multidisciplinary teams including speech language pathologists (SLP) and in an increasing number of institutions also respiratory therapists (RT). Objective: This study analyzes the role, the competencies, the collaboration and their mutual perception of SLPs and RTs involved in ENNR Weaning. Methods: Two profession-specific web-based surveys (43 items each) were developed to assess work experience, interventions in tracheostomy, communication, secretion and dysphagia management and perceived therapists' role within the multidisciplinary team. Surveys were distributed to ENNR units and center. Results: Twenty-seven SLPs and sixteen RTs completed the surveys. SLPs reported more ENNR-specific experience, whereas RTs had more overall clinical experience. Both professions rated their own recommendations-regarding tracheostomy tube selection, timing of cuff deflation, choice of communication methods, and secretion-management strategies-as more important than those of the other group. Both agreed that dysphagia assessment is primarily an SLP responsibility. However, they differed on whether all patients should undergo instrumental examinations such as FEES or tracheoscopy, despite broad agreement on the objectives of these procedures. Both professions regularly trained other team members in tracheostomy management, dysphagia, weaning, and FEES, underscoring their educational roles within the team. Conclusion: As RTs become more involved in ENNR weaning, enhanced interprofessional education is necessary, particularly regarding communication-focused interventions. Clear job descriptions and SOPs should define shared objectives, procedures, and responsibilities. Training should emphasize above-cuff vocalization, in-line speaking valves (e.g., Passy Muir Valve), and appropriate timing of FEES and tracheoscopy. A targeted educational program for both professions-and for the broader weaning team-may support more efficient weaning, improved communication and swallowing, and better overall patient outcomes.