409 – FEES in the CICU: What 58% of Cardiac Centers Are Doing Without Any Guidelines

On this episode of The Swallow Your Pride Podcast, Karli Negrin, MA, CCC-SLP, joins the show to talk about what happens when the clinical guidelines say one thing and the babies in front of you need another. Karli has spent nearly two decades in the cardiac intensive care unit at Nemours Children's Health working with infants with critical congenital heart disease. When she wanted to start using FEES with her breastfed post-op patients, her cardiac team asked for a literature review. She went looking and found almost nothing. So she and a multi-site team of cardiac SLPs, an aerodigestive chair, and a cardiac intensivist ran a survey of practice instead. What they found: 58% of responding centers are performing FEES in the CICU, 71% of those still prefer VFSS as their primary instrumental exam, and most are doing it without lesion-specific inclusion criteria or physiologic stopping parameters. In this conversation, Karli breaks down why NICU feeding research doesn't transfer cleanly to term infants with cCHD, why aspiration risk shows up regardless of surgical STAT category or vocal fold mobility, how coupling FEES with the postoperative NPL could work (and where it gets complicated), and the research article on parental role alteration that changed the way she approaches every bedside. She also makes the case that you do not need a PhD to start collecting data on a clinical question you can't find the answer to. Research source: Negrin K, Willette S, Godsil J, LaManna S, Garcia R, Morris K, Jones C, Morrow M, Wiscount J, Meyer-Macaulay C, Aaronson N, Reynolds J. Perioperative Management of Dysphagia Within the Cardiac Intensive Care Unit Utilizing Flexible Endoscopic Evaluation of Swallowing: A Survey of Practice. Am J Speech Lang Pathol. 2026 Mar 10;35(2):763-771. doi: 10.1044/2025_AJSLP-25-00100. Epub 2026 Feb 24. PMID: 41734216. Show notes: https://syppodcast.com/409