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Guillen-Sola A, Ramírez C, Nieto S, Duarte E, Tejero M, Grillo C, Bel H, Boza R. Therapeutic approach to dysphagia in post-COVID patients in a rehabilitation unit: a descriptive longitudinal study. Eur J Phys Rehabil Med 2024; 60:373-381. [PMID: 38502558 DOI: 10.23736/s1973-9087.24.08234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND A high rate of hospitalized patients for COVID-19 had dysphagia, frequently underdiagnosed, and not treated, inducing a prolonged dysphagia with protracted recovery. Specific treatments and protocols have not been well described yet. AIM Given the potential benefits of respiratory muscle training (IEMT) and neuromuscular stimulation (NMES) in dysphagia treatment, this study aimed to assess the feasibility of the protocol used for treating dysphagia in patients who experienced prolonged hospitalization for COVID-19. DESIGN Observational, descriptive, prospective study. SETTING Department of Physical Medicine and Rehabilitation of a tertiary University hospital. POPULATION Fifty-eight COVID-19 patients were admitted for intensive rehabilitation (March 2020 to October 2021) were prospectively studied. METHODS Dysphagia was diagnosed using videofluoroscopy and treated with a 3-week protocol adapted from neuromuscular stimulation (NMES) in a motor threshold and inspiratory/expiratory muscle strength training (IEMST), five sets of five repetitions three times daily for 3 weeks. Feasibility was assessed with adherence, outcomes achieved, and occurrence of adverse/unexpected events. Respiratory function (peak cough flow, maximal inspiratory/expiratory pressures) and swallow function (Penetration-Aspiration Scale and Bolus Residue Scale measured by videofluoroscopy) were recorded descriptive statistics, Student's t test for numerical data, and Wilcoxon Test for ordinal variables were applied. SPPSS vs28 and STATA version 15.1 (StataCorp, College Station, TX, USA) were used for statistical analysis. P values 0.05 were considered significant. RESULTS Dysphagia was highly prevalent in severe COVID-19 patients (86.6%); all respiratory and swallow parameters improved after a 3-week intervention and 12 of 18 patients dependent on tube feeding resumed a normal diet (66.7%; McNemar P=0.03), and 84.09% attended a no restriction diet at discharge. Adherence to treatment was 85%. No significant adverse events were detected. CONCLUSIONS We conclude that a structured swallowing-exercise training intervention based on IEMT and NMES is feasible and safe in prolonged hospitalization post-COVID patients. CLINICAL REHABILITATION IMPACT To describe rehabilitation protocols used to treat dysphagia in post-COVID patients will help us to optimize the available techniques in each center and to induce a faster recovery avoiding potential complications.
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Affiliation(s)
- Anna Guillen-Sola
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain -
- Rehabilitation Research Group, Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain -
| | - Cindry Ramírez
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Sonia Nieto
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
| | - Esther Duarte
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Marta Tejero
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
| | - Christian Grillo
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
| | - Helena Bel
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
| | - Roser Boza
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
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Martín-Martínez A, Viñas P, Carrillo I, Martos J, Clavé P, Ortega O. The Impact of Frailty, Oropharyngeal Dysphagia and Malnutrition on Mortality in Older Patients Hospitalized for Covid-19. Aging Dis 2024; 15:927-938. [PMID: 37548930 PMCID: PMC10917529 DOI: 10.14336/ad.2023.0425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/25/2023] [Indexed: 08/08/2023] Open
Abstract
COVID-19 hospital mortality is higher among older patients through as yet little-known factors. We aimed to assess the effect of frailty (FR), oropharyngeal dysphagia (OD) and malnutrition (MN) on mortality in hospitalized COVID-19 older patients. Prospective cohort study of older patients (>70 years) with COVID-19 admitted to a general hospital from April 2020 to January 2021. Patients were evaluated on admission, discharge and at 1- and 3-months follow up. FR was assessed with FRAIL-VIG, OD with Volume-Viscosity Swallowing Test and MN with GLIM criteria. Clinical characteristics and outcomes, including intra-hospital, 1- and 3-month mortality, were analyzed. 258 patients were included (82.5±7.6 years; 58.9% women); 66.7% had FR (mild 28.7%, moderate 27.1% and severe 10.9%); 65.4%, OD and 50.6%, MN. OD prevalence increased from non-FR patients through the severity levels of FR: mild, moderate and severe (29.8%, 71.6%, 90.0%, 96.2%; p<0.0001, respectively), but not that of MN (50.6%, 47.1%, 52.5%, 56.0%). Mortality over the whole study significantly increased across FR categories (9.3% non-FR; 23.0% mild; 35.7% moderate; 75.0% severe; p<.001). Functionality (Barthel pre-admission, HR=0.983, CI-95%:0.973-0.993; p=0.001), OD (HR=2.953, CI-95%:0.970-8.989; p=0.057) and MN (HR=4.279, CI-95%:1.658-11.049; p=0.003) were independent risk factors for intra-hospital mortality. FR, OD and MN are highly prevalent conditions in older patients hospitalized with COVID-19. Functionality, OD and MN were independent risk factors for intra-hospital mortality.
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Affiliation(s)
- Alberto Martín-Martínez
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.
| | - Paula Viñas
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
| | - Irene Carrillo
- Department of Geriatrics, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain.
| | - Josep Martos
- Department of Geriatrics, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain.
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.
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Clayton NA, Freeman-Sanderson A, Walker E. Dysphagia Prevalence and Outcomes Associated with the Evolution of COVID-19 and Its Variants in Critically Ill Patients. Dysphagia 2024; 39:109-118. [PMID: 37347254 PMCID: PMC10781836 DOI: 10.1007/s00455-023-10598-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/30/2023] [Indexed: 06/23/2023]
Abstract
Data collected during the 2020-21 COVID-19 alpha wave indicated dysphagia prevalence rates up to 93%. Whilst many patients recovered during hospital admission, some experienced persistent dysphagia with protracted recovery. To explore (1) prevalence, (2) treatment, and (3) recovery patterns and outcomes for swallowing, in the ICU patient with Delta and subsequent variants of COVID-19. Prospective observational study. Patients admitted to 26 Intensive Care Units (ICUs) over 12 months, diagnosed with COVID-19, treated for survival and seen by Speech-Language Pathology (SLP) for clinical swallowing assessment were included. Demographic, medical, SLP treatment, and swallowing outcome data were collected. 235 participants (63% male, median age = 58 years) were recruited. Median mechanical ventilation was 16 days, and ICU and hospital length of stay (LOS) were 20 and 42 days, respectively. ICU-Acquired Weakness (54%) and delirium (49%) were frequently observed. Prevalence of dysphagia was 94% with the majority (45%) exhibiting profound dysphagia (Functional Oral Intake Scale = 1) at initial assessment. Median duration to initiate oral feeding was 19 days (IQR = 11-44 days) from ICU admission, and 24% received dysphagia rehabilitation. Dysphagia recovery by hospital discharge was observed in 71% (median duration = 30 days [IQR = 17-56 days]). Positive linear associations were identified between duration of intubation, mechanical ventilation, hospital and ICU LOS, and duration to SLP assessment (p = 0.000), dysphagia severity (p = 0.000), commencing oral intake (p = 0.000), dysphagia recovery (p < 0.01), and enteral feeding (p = 0.000). Whilst older participants had more severe dysphagia (p = 0.028), younger participants took longer to commence oral feeding (p = 0.047). Dysphagia remains highly prevalent in ICU COVID-19 patients. Whilst invasive ventilation duration is associated with swallowing outcomes, more evidence on dysphagia pathophysiology is required to guide rehabilitation.
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Affiliation(s)
- Nicola A Clayton
- Speech Pathology Department & Intensive Care Unit, Concord Repatriation General Hospital, Building 42, Hospital Rd, Concord, Sydney, NSW, 2139, Australia.
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Amy Freeman-Sanderson
- Speech Pathology Department & Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
- Critical Care Division, The George Institute for Global Health, Sydney, NSW, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Walker
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Goodman DA, Jensen A, Fahey K, Walaszek E, Vail C, Nassiri K, Jayabalan P, Oswald M, Rydberg L. Functional improvements of patients admitted to an inpatient rehabilitation facility after bilateral lung transplant due to severe COVID-19 pulmonary disease. PM R 2024; 16:25-35. [PMID: 37272798 DOI: 10.1002/pmrj.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 04/08/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Coronavirus disease (COVID-19) has introduced a new subset of patients with acute end-stage lung damage for which lung transplantation has been successfully performed. OBJECTIVE To describe the inpatient rehabilitation course of patients who underwent bilateral lung transplant due to severe COVID-19 pulmonary disease. DESIGN Retrospective chart review. SETTING Free-standing, academic, urban inpatient rehabilitation hospital. PARTICIPANTS Seventeen patients aged 28-67 years old (mean 53.9 ± 10.7) who developed COVID-19 respiratory failure and underwent bilateral lung transplant. INTERVENTIONS Patients participated in a comprehensive inpatient rehabilitation program including physical, occupational, and speech therapy tailored to the unique functional needs of each individual. MAIN OUTCOME MEASURES Primary outcome measures of functional improvements, include mobility and self-care scores on section GG of the Functional Abilities and Goals of the Improving Post-Acute Care Transformation Act, as defined as quality measures by the Centers for Medicare and Medicaid Services. Other functional measures included 6 minute walk test, Berg balance scale, Mann Assessment of Swallowing Ability (MASA), and Cognition and Memory Functional Independence Measure (FIM) scores. Wilcoxon signed rank sum test was used to evaluate statistical significance of change between admission and discharge scores. RESULTS Fourteen patients completed inpatient rehabilitation. Self-care (GG0130) mean score improved from 20.9 to 36.1. Mobility (GG0170) mean score improved from 30.7 to 70.7. Mean 6-minute walk distance improved from 174.1 to 467.6 feet. Mean Berg balance scores improved from 18.6/56 to 36.3/56. MASA scores improved from 171.3 to 182.3. All functional measures demonstrated statistically significant improvements with p value ≤ .008, except for cognition and memory FIM scores, which did not show a statistically significant difference. A majority (76%) of patients discharged home. CONCLUSION This new and unique patient population can successfully participate in a comprehensive inpatient rehabilitation program and achieve functional improvements despite medical complications.
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Affiliation(s)
| | | | - Kyle Fahey
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Amita Resurrection Health, Chicago, IL, United States
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Ceravolo MG, Anwar F, Andrenelli E, Udensi C, Qureshi J, Sivan M, Kiekens C, Zampolini M. Evidence-based position paper on physical and rehabilitation medicine professional practice for persons with COVID-19, including post COVID-19 condition: the European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2023; 59:789-799. [PMID: 38214046 DOI: 10.23736/s1973-9087.23.08315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Although multiple factors still pose challenges to inpatient/outpatient rehabilitation for survivors of COVID-19, rehabilitation plays a key role for this patient population. This study aimed to improve Physical and Rehabilitation Medicine (PRM) physician's professional practice for persons with COVID-19-related functioning limitations, to promote functional recovery and reduce activity limitations and/or participation restrictions. A systematic review of the scientific literature was performed from December 2019 to August 2022, followed by production of recommendations through 5 Delphi rounds, by consensus among the delegates of all European countries represented in the Union of European Medical Specialists PRM Section. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The PRM physician's role for persons with COVID-19-related limitations of functioning is to develop, foster, and monitor the implementation of an individual rehabilitation project tailored to the patient's age, previous medical and functional status, current comorbidities and complications, activity limitations and participation restrictions and personal and environmental factors. This is done by applying the concept of a multi-specialty integrated service model with multi-professional/interdisciplinary teams, providing care at all stages of COVID-19 illness. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section.
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Affiliation(s)
- Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy
| | - Fahim Anwar
- Department of Rehabilitation Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy -
| | - Cynthia Udensi
- Department of Rehabilitation Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jawaria Qureshi
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Manoj Sivan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds General Infirmary, University of Leeds, Leeds, UK
| | | | - Mauro Zampolini
- Department of Rehabilitation, Hospital of Foligno, USL Umbria2, Perugia, Italy
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Chalmers S, Harrall K, Wong SY, Kablan W, Clunie G. A retrospective study of patients presenting with speech and language therapy needs within multidisciplinary Long COVID services: A service evaluation describing and comparing two cohorts across two NHS Trusts. Int J Lang Commun Disord 2023; 58:1424-1439. [PMID: 36916685 DOI: 10.1111/1460-6984.12868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Post-COVID Syndrome (also known as Long COVID) refers to the multi-system condition affecting individuals following COVID-19 infection. This can include speech and language therapy (SLT) needs, including voice, swallowing, communication and upper airway difficulties. There is limited published literature in this clinical area of practice, particularly for those receiving input from community SLT services. AIMS To describe and compare demand, typical SLT presentation and service delivery across two National Health Service (NHS) Long COVID multidisciplinary services. Independent retrospective service evaluation was completed for each service. Descriptive statistics were produced and compared across services. This service evaluation followed The Strengthening the Reporting of Observation Studies in Epidemiology guidelines for cohort studies. OUTCOMES & RESULTS The findings indicated similarities across the two services in SLT service need and demand, clinical presentations and intervention approaches provided within Long COVID services. There were specific differences in the service provision and delivery of intervention in cognitive communication and upper airways subspecialities. CONCLUSIONS & IMPLICATIONS This study highlights the clinical complexities of SLT needs in individuals with Long COVID and the importance for an appropriately skilled and supported workforce within effective multidisciplinary teams. We call for consensus on SLT practices and a consistent and standardized approach to evaluation for SLT needs in Long COVID. WHAT THIS PAPER ADDS What is already known on this subject SLT needs, including voice, swallowing, communication and upper airway difficulties, are present in individuals presenting with Long COVID, both in those who were or were not hospitalized. SLTs are seeing such individuals in a variety of settings, including community services and Long COVID multidisciplinary teams. There is minimal evidence of the clinical presentations and interventions provided to individuals with SLT needs compared across Long COVID services. What this study adds to existing knowledge This study compares two NHS Long COVID services providing a SLT service pathway. It highlights the similarities and differences in service demand and capacity, patient presentation, and SLT intervention to make suggestions for future practice consideration and priority evaluation. Expert consensus among SLT clinicians is a priority to ensure clinicians are delivering consistent and equitable care for patients, while new evidence and data emerge. A consistent and standardized approach to data collection and outcome measures is essential to ensure future research captures the impact and value of SLT input with individuals with Long COVID. What are the clinical implications of this work? The complexities and multifactorial SLT needs of individual with Long COVID call for appropriate SLT staffing provision, skill and training to fulfil the needs of this population. Speech and language therapists should be integrated with multidisciplinary Long COVID services to provide holistic care for patients and to support the professionals working with individuals with post-COVID voice, swallowing, communication and upper airway symptoms.
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Affiliation(s)
- Sophie Chalmers
- Long COVID Service, Long Term Conditions, Integrated Community Services Division, Bolton NHS Foundation Trust, Bolton, UK
- Allied Health Research Unit, School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Kate Harrall
- Speech and Language Therapy Dept, Integrated Pathways Division, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
- Research and Development Unit, Strategy, Research and Innovation Division, East Suffold and North Essex NHS Foundation Trust, Colchester, UK
| | - Sze Yin Wong
- Speech and Language Therapy Dept, Integrated Pathways Division, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Widad Kablan
- Paediatric Speech and Language Therapy, Family Care Division, Bolton NHS Foundation Trust, Bolton, UK
| | - Gemma Clunie
- Speech and Language Therapy, Surgery and Cancer, Imperial College London Healthcare NHS Trust & Imperial College London, London, UK
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Armas-Navarro LP, Santana-Padilla YG, Mendoza-Segura L, Ramos-Díaz M, Santana-López BN, Alcaraz-Jiménez JA, Rico-Rodríguez J, Santana-Cabrera L. Dysphagia in intensive care, a real problem: analysis of risk factors. Enferm Intensiva (Engl Ed) 2023; 34:115-125. [PMID: 36935305 DOI: 10.1016/j.enfie.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/08/2022] [Indexed: 03/19/2023]
Abstract
AIMS To identify risk factors present in patients with dysphagia in a population of critically ill patients. METHODS Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. OUTCOMES 103 patients were recruited from 401 possible. The mean age was 59,33 ± 13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74 ± 6,17) and Charlson (2,98 ± 3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p < 0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65; 95% CI:1,31-16,47; p = 0,014) and a hospital stay (OR: 8,50; 95%CI: 2,20-32,83; p < 0,001) On discharge from the ICU, 37,9% of the population still had dysphagia; 12,6% maintained this problem at hospital discharge. CONCLUSIONS Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization.
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Affiliation(s)
- L P Armas-Navarro
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - Y G Santana-Padilla
- Area Quirúrgica del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - L Mendoza-Segura
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - M Ramos-Díaz
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - B N Santana-López
- Unidad de Medicina Intensiva del Hospital Universitario de Gran Canaria Dr. Negrín, Canary Islands, Spain
| | - J A Alcaraz-Jiménez
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - J Rico-Rodríguez
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | - L Santana-Cabrera
- Unidad de Medicina Intensiva de adultos del Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain.
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Dawson C, Nankivell P, Pracy JP, Capewell R, Wood M, Weblin J, Parekh D, Patel J, Skoretz SA, Sharma N. Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study. Dysphagia 2023; 38:657-666. [PMID: 35841455 PMCID: PMC9287536 DOI: 10.1007/s00455-022-10496-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/01/2022] [Indexed: 11/03/2022]
Abstract
To explore laryngeal function of tracheostomised patients with COVID-19 in the acute phase, to identify ways teams may facilitate and expedite tracheostomy weaning and rehabilitation of upper airway function. Consecutive tracheostomised patients underwent laryngeal examination during mechanical ventilation weaning. Primary outcomes included prevalence of upper aerodigestive oedema and airway protection during swallow, tracheostomy duration, ICU frailty scores, and oral intake type. Analyses included bivariate associations and exploratory multivariable regressions. 48 consecutive patients who underwent tracheostomy insertion as part of their respiratory wean following invasive ventilation in a single UK tertiary hospital were included. 21 (43.8%) had impaired airway protection on swallow (PAS ≥ 3) with 32 (66.7%) having marked airway oedema in at least one laryngeal area. Impaired airway protection was associated with longer total artificial airway duration (p = 0.008), longer tracheostomy tube duration (p = 0.007), multiple intubations (p = 0.006) and was associated with persistent ICU acquired weakness at ICU discharge (p = 0.03). Impaired airway protection was also an independent predictor for longer tracheostomy tube duration (p = 0.02, Beta 0.38, 95% CI 2.36 to 27.16). The majority of our study patients presented with complex laryngeal findings which were associated with impaired airway protection. We suggest a proactive standardized scoring and review protocol to manage this complex group of patients in order to maximize health outcomes and ICU resources. Early laryngeal assessment may facilitate weaning from invasive mechanical ventilation and liberation from tracheostomy, as well as practical and objective risk stratification for patients regarding decannulation and feeding.
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Affiliation(s)
- C Dawson
- Department of Therapy Services, Queen Elizabeth Hospital Birmingham NHSFT, Birmingham, UK.
- University of Birmingham Institute of Clinical Sciences, Birmingham, UK.
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada.
| | - P Nankivell
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UK
| | - J P Pracy
- Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UK
| | - R Capewell
- Department of Therapy Services, Queen Elizabeth Hospital Birmingham NHSFT, Birmingham, UK
| | - M Wood
- Department of Therapy Services, Queen Elizabeth Hospital Birmingham NHSFT, Birmingham, UK
| | - J Weblin
- Department of Therapy Services, Queen Elizabeth Hospital Birmingham NHSFT, Birmingham, UK
| | - D Parekh
- Centre for Translational Inflammation and Fibrosis Research, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - J Patel
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - S A Skoretz
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Providence Health Care, Vancouver, Canada
| | - N Sharma
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UK
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Hou L, Li Y, Wang J, Wang Y, Wang J, Hu G, Ding XR. Risk factors for post-extubation dysphagia in ICU: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33153. [PMID: 36897733 PMCID: PMC9997834 DOI: 10.1097/md.0000000000033153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Post-extubation dysphagia is high in critically ill patients and is not easily recognized. This study aimed to identify risk factors for acquired swallowing disorders in the intensive care unit (ICU). METHODS We have retrieved all relevant research published before August 2022 from PubMed, Embase, Web of Science, and the Cochrane Library electronic databases. The studies were selected using inclusion and exclusion criteria. Two reviewers screened studies, extracted data, and independently evaluated the risk of bias. The quality of the study was assessed with the Newcastle-Ottawa Scale, and a meta-analysis was carried out with Cochrane Collaboration's Revman 5.3 software. RESULTS A total of 15 studies were included. Age (odds ratio [OR] = 1.04), tracheal intubation time (OR = 1.61), APACHE II (OR = 1.04), and tracheostomy (OR = 3.75) were significant risk factors that contributed to post-extubation dysphagia in ICU. CONCLUSION This study provides preliminary evidence that post-extraction dysphagia in ICU is associated with factors such as age, tracheal intubation time, APACHE II, and tracheostomy. The results of this research may improve clinician awareness, risk stratification, and prevention of post-extraction dysphagia in the ICU.
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Affiliation(s)
- Lingyu Hou
- Nursing Department, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Ying Li
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Jianhua Wang
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Yuqi Wang
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Jingchao Wang
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - GuoJing Hu
- College of Nursing, Weifang Institute of Science and Technology, Shandong, Weifang, People’s Republic of China
| | - Xiao Rong Ding
- Nursing Department, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
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10
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Gabunia S, Harmon EY, Sonagere MB, Teale AE. Characteristics and Outcomes of COVID-19 Survivors Requiring Inpatient Rehabilitation: A Comparison of Two Waves. Am J Phys Med Rehabil 2023; 102:206-213. [PMID: 35762847 PMCID: PMC9940787 DOI: 10.1097/phm.0000000000002059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Many survivors of severe or critical COVID-19 have required rehabilitation during the pandemic. The primary objective was to compare characteristics and outcomes of survivors of severe or critical COVID-19 admitted to the inpatient rehabilitation facility during the first two waves of the pandemic. Our secondary objective was to identify the factors contributing to functional dependence on admission, discharge, and length of stay. DESIGN This is a retrospective cohort study of 138 patients admitted to an inpatient rehabilitation facility in two waves after hospitalization for severe or critical COVID-19 illness between April 1, 2020, and May 3, 2021. RESULTS Inpatient rehabilitation facility patients in wave 2 had significantly greater functional independence (GG scores) on admission (52; interquartile range, 44-58 vs 41; interquartile range, 28-52), lower incidence of dysphagia and anemia. The patients in both waves experienced similar functional improvement efficiencies with a median GG score change of 3.6 per day and similar discharge GG scores. Neurological sequela (odds ratio, 0.12; P < 0.001) and anemia (odds ratio, 1.35; P < 0.002) were identified as independent predictors of functional independence on admission. CONCLUSIONS Patients with functional deficits after COVID-19 should be considered for acute inpatient rehabilitation as both patient cohorts benefited from their inpatient rehabilitation facility stays with similar length of stays (11-12 days) and discharge to home rates (88%-90%).
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Lin CW, Chiang TY, Chen WC, Chiu LW, Su YC, Lin HC, Chang CT. Is Postextubation Dysphagia Underestimated in the Era of COVID-19? A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 168:935-943. [PMID: 36842159 DOI: 10.1002/ohn.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To investigate the incidence rate of postextubation dysphagia (PED) in patients with COVID-19, as well as relative factors potentially influencing the clinical course of dysphagia. DATA SOURCES Six databases including PubMed, MEDLINE, Embase, ScienceDirect, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were searched with no restriction on the language. REVIEW METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data were extracted and cross-examined among 3 of the authors. The random-effects model was adopted for the statistical synthesis. The percentage and 95% confidence interval (CI) were adopted as the effect measurements of the PED incidence rate. Subgroup analyses, sensitivity analyses, and metaregression were also performed to identify the heterogeneity among the studies. RESULTS A total of 594 patients were enrolled and analyzed from the 10 eligible studies. The weighted incidence of PED in patients with COVID-19 was 66.5% (95% CI: 49.7%-79.9%). Age was the potential factor influencing the incidence rate after heterogeneity was adjusted by the metaregression analysis. CONCLUSION Compared to the current evidence reporting only 41% of the non-COVID patients experienced PED, our study further disclosed that a higher 66.5% of COVID-19 patients suffered from PED, which deserves global physicians' attention. With the association between COVID-19 and dysphagia having been more clearly understood, future clinicians are suggested to identify intubated patients' risk factors earlier to strengthen PED care programs in the era of COVID-19.
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Affiliation(s)
- Chung-Wei Lin
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ting-Yi Chiang
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wen-Ching Chen
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Wen Chiu
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yung-Chung Su
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Ching Lin
- Department of Otolaryngology, Division of Laryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Business Management and Institute of Biomedical Science, Institute of Healthcare Management, National Sun Yat-sen University, Kaohsiung, Taiwan.,Sleep Center, Robotic Surgery Center and Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chun-Tuan Chang
- Department of Business Management and Institute of Biomedical Science, Institute of Healthcare Management, National Sun Yat-sen University, Kaohsiung, Taiwan
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12
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Zayed AM, Afsah O, Elhadidy T, Abou-Elsaad T. Screening for oropharyngeal dysphagia in hospitalized COVID-19 patients: a prospective study. Eur Arch Otorhinolaryngol 2023; 280:2623-2631. [PMID: 36607433 PMCID: PMC9821362 DOI: 10.1007/s00405-022-07810-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/14/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To screen for oropharyngeal dysphagia (OD) in hospitalized COVID-19 patients. METHODS A descriptive longitudinal study was conducted on 500 adult patients with confirmed COVID-19 in the age range of 19-65 years who were admitted to the main university isolation hospital (whether admitted in the ward or the intensive care unit). Screening for OD was done using the Arabic version of the Eating Assessment Tool (EAT-10) and the Yale swallow protocol. RESULTS 45.4% of the admitted and 40.97% of the discharged COVID-19 patients had a positive screen for OD. Several risk factors for OD could be detected. These include older age, longer duration of presenting symptoms of COVID-19, presence of ageusia and anosmia, presence of dysphonia, ICU admission, lower oxygen saturation, higher respiratory rate, presence of OD at admission, longer duration of hospital stay, and use of noninvasive ventilation (NIV) and/or invasive mechanical ventilation (IMV). CONCLUSIONS Screening for OD in hospitalized COVID-19 patients is a mandatory procedure, whether for admitted or discharged patients.
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Affiliation(s)
- Ahmed Mohamed Zayed
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
| | - Omayma Afsah
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
| | - Tamer Elhadidy
- Chest Diseases Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Tamer Abou-Elsaad
- Phoniatric Unit, ORL Department, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt.
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13
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Armas-Navarro L, Santana-Padilla Y, Mendoza-Segura L, Ramos-Díaz M, Santana-López B, Alcaraz-Jiménez J, Rico-Rodríguez J, Santana-Cabrera L. La disfagia en cuidados intensivos, un problema real: análisis de factores de riesgo. Enfermería Intensiva 2022. [DOI: 10.1016/j.enfi.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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14
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Miles A, Brodsky MB. Current opinion of presentation of dysphagia and dysphonia in patients with coronavirus disease 2019. Curr Opin Otolaryngol Head Neck Surg 2022; 30:393-399. [PMID: 36004777 PMCID: PMC9612417 DOI: 10.1097/moo.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Dysphagia and dysphonia are common presentations of both acute and long coronavirus disease 2019 (COVID-19). The majority of peer-reviewed publications in 2020 and early 2021 were expert guidance and consensus statements to support dysphagia management in multidisciplinary teams while protecting clinicians and patients from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. This review discusses dysphagia and dysphonia primary data published in 2021-2022, focusing on patient presentations, pathophysiology, and evidence for interventions. RECENT FINDINGS Clinicians and researchers amassed knowledge of the cross-system presentation of dysphagia and dysphonia in patients with COVID-19, from severe disease requiring ICU stays to those with mild-to-moderate disease presenting to outpatient clinics. Pre-COVID-19 health status, hospitalization experience, presence of neurological symptoms, and impact of the virus to the upper aerodigestive and respiratory system need consideration in patient management. Long-term dysphagia and dysphonia manifested from COVID-19 require otolaryngologist and speech-language pathologist input. SUMMARY Changes in immunity through population vaccination and variations in COVID-19 from SARS-CoV-2 mutations means prevalence data are challenging to interpret. However, there is no doubt of the presence of long-term dysphagia and dysphonia in our clinics. Long-term dysphagia and dysphonia are complex and a multidisciplinary team with a tailored approach for each patient is required.
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Affiliation(s)
- Anna Miles
- The University of Auckland, Auckland, New Zealand
| | - Martin B. Brodsky
- Department of Physical Medicine and Rehabilitation; Department of Medicine, Division of Pulmonary and Critical Care Medicine; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, USA
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15
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Martin-Martinez A, Ortega O, Viñas P, Arreola V, Nascimento W, Costa A, Riera SA, Alarcón C, Clavé P. COVID-19 is associated with oropharyngeal dysphagia and malnutrition in hospitalized patients during the spring 2020 wave of the pandemic. Clin Nutr 2022; 41:2996-3006. [PMID: 34187698 PMCID: PMC8205257 DOI: 10.1016/j.clnu.2021.06.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Prevalence and complications of oropharyngeal dysphagia (OD) and malnutrition (MN) in COVID-19 patients is unknown. Our aim was to assess the prevalence, risk factors and clinical outcomes of OD and MN in a general hospital during the first wave of the COVID-19 pandemic. METHODS This was a prospective, observational study involving clinical assessment of OD (Volume-Viscosity Swallowing Test), and nutritional screening (NRS2002) and assessment (GLIM criteria) in COVID-19 patients hospitalized in general wards at the Consorci Sanitari del Maresme, Catalonia, Spain. The clinical characteristics and outcomes of patients were assessed at pre-admission, admission and discharge, and after 3 and 6-months follow-up. RESULTS We included 205 consecutive patients (69.28 ± 17.52 years, Charlson 3.74 ± 2.62, mean hospital stay 16.8 ± 13.0 days). At admission, Barthel Index was 81.3 ± 30.3; BMI 28.5 ± 5.4 kg/m2; OD prevalence 51.7% (44.1% impaired safety of swallow); and 45.5% developed MN with a mean weight loss of 10.1 ± 5.0 kg during hospitalization. OD was an independent risk factor for MN during hospitalization (OR 3.96 [1.45-10.75]), and hospitalization was prolonged in patients with MN compared with those without (21.9 ± 14.8 vs 11.9 ± 8.9 days, respectively; p < 0.0001). OD was independently associated with comorbidities, neurological symptoms, and low functionality. At 6-month follow-up, prevalence of OD was still 23.3% and that of MN only 7.1%. Patients with OD at discharge showed reduced 6-month survival than those without OD at discharge (71.6% vs 92.9%, p < 0.001); in contrast, those with MN at discharge did not show 6-month survival differences compared to those without (85.4% vs 83.8%, p = 0.8). CONCLUSIONS Prevalence and burden of OD and MN in patients hospitalized in COVID-19 wards is very high. Our results suggest that optimizing the management of MN might shorten the hospitalization period but optimizing the management of OD will likely impact the nutritional status of COVID-19 patients and improve their clinical outcomes and survival after hospital discharge. CLINICALTRIALS gov Identifier: NCT04346212.
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Affiliation(s)
- Alberto Martin-Martinez
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Paula Viñas
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Viridiana Arreola
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Weslania Nascimento
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Alícia Costa
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Stephanie A Riera
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Claudia Alarcón
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
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16
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Miles A, McRae J, Clunie G, Gillivan-Murphy P, Inamoto Y, Kalf H, Pillay M, Pownall S, Ratcliffe P, Richard T, Robinson U, Wallace S, Brodsky MB. An International Commentary on Dysphagia and Dysphonia During the COVID-19 Pandemic. Dysphagia 2022; 37:1349-1374. [PMID: 34981255 PMCID: PMC8723823 DOI: 10.1007/s00455-021-10396-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/01/2021] [Indexed: 12/16/2022]
Abstract
COVID-19 has had an impact globally with millions infected, high mortality, significant economic ramifications, travel restrictions, national lockdowns, overloaded healthcare systems, effects on healthcare workers' health and well-being, and large amounts of funding diverted into rapid vaccine development and implementation. Patients with COVID-19, especially those who become severely ill, have frequently developed dysphagia and dysphonia. Health professionals working in the field have needed to learn about this new disease while managing these patients with enhanced personal protective equipment. Emerging research suggests differences in the clinical symptoms and journey to recovery for patients with COVID-19 in comparison to other intensive care populations. New insights from outpatient clinics also suggest distinct presentations of dysphagia and dysphonia in people after COVID-19 who were not hospitalized or severely ill. This international expert panel provides commentary on the impact of the pandemic on speech pathologists and our current understanding of dysphagia and dysphonia in patients with COVID-19, from acute illness to long-term recovery. This narrative review provides a unique, comprehensive critical appraisal of published peer-reviewed primary data as well as emerging previously unpublished, original primary data from across the globe, including clinical symptoms, trajectory, and prognosis. We conclude with our international expert opinion on what we have learnt and where we need to go next as this pandemic continues across the globe.
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Affiliation(s)
- Anna Miles
- Speech Science, School of Psychology, The University of Auckland, Grafton Campus, Private Bag 92019, Auckland, New Zealand.
| | - Jackie McRae
- Centre for Allied Health, St George's, University of London/University College London Hospitals NHS Foundation Trust, London, UK
| | - Gemma Clunie
- Imperial College London & Clinical Specialist SLT (Airways/ENT), Imperial College Healthcare NHS Trust, London, UK
| | - Patricia Gillivan-Murphy
- Clinical Specialist SLT, Voice & Swallowing Clinic, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Yoko Inamoto
- SLHT, Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Hanneke Kalf
- Division of Speech Pathology, Department of Rehabilitation, Radboud University Medical Centre / Donders Centre for Neuroscience, Nijmegen, The Netherlands
| | - Mershen Pillay
- Speech-Language Therapy, University of KwaZulu-Natal, Durban, South Africa
| | - Susan Pownall
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Philippa Ratcliffe
- Consultant SLT Royal National ENT and EDH University College London Hospitals NHS Foundation Trust, London, UK
| | - Theresa Richard
- Mobile Dysphagia Diagnostics, Medical SLP Collective, Buffalo, USA
| | - Ursula Robinson
- SLT, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - Sarah Wallace
- Consultant SLT, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Martin B Brodsky
- Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
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17
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Bordejé Laguna L, Marcos-Neira P, de Lagrán Zurbano IM, Marco EM, Guisasola CP, Viñas Soria CD, Martí PR. Dysphagia and mechanical ventilation in SARS-COV-2 pneumonia: It's real. Clin Nutr 2022; 41:2927-33. [PMID: 34879968 DOI: 10.1016/j.clnu.2021.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/27/2021] [Accepted: 11/19/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Dysphagia can be a consequence of prolonged hospitalization in intensive care units (ICUs) due to severe SARS-CoV-2 pneumonia. This study aims at Identifying the risk factors for dysphagia in ICU patients with COVID-19 pneumonia requiring invasive mechanical ventilation, and at determining the frequency of postextubation dysphagia in this population. METHODS Observational, descriptive, retrospective, cohort study of SARS-CoV-2 pneumonia patients admitted into the ICUs from March to May 2020. The Modified Viscosity Volume Swallowing Test (mV-VST) was used to screening for dysphagia during the first 48 h of extubation in patients requiring mechanical ventilation. Descriptive statistics, univariate and multivariate analyses were conducted. A logistic regression was applied to construct a predictive model of dysphagia. RESULTS A total of 232 patients were admitted into the ICUs (age [median 60.5 years (95% CI: 58.5 to 61.9)]; male [74.1% (95% CI: 68.1 to 79.4)]; APACHE II score [median 17.7 (95% CI: 13.3 to 23.2)]; length of mechanical ventilation [median 14 days (95% CI: 11 to 16)]; prone position [79% (95% CI: 72.1 to 84.6)]; respiratory infection [34.5% (95% CI: 28.6 to 40.9)], renal failure [38.5% (95% CI: 30 to 50)])). 72% (167) of patients required intubation; 65.9% (110) survived; and in 84.5% (93) the mV-VST was performed. Postextubation dysphagia was diagnosed in 26.9% (25) of patients. APACHE II, prone position, length of ICU and hospital stay, length of mechanical ventilation, tracheostomy, respiratory infection and kidney failure developed during admission were significantly associated (p < 0.05) with dysphagia. Dysphagia was independently explained by the APACHE II score (OR: 1.1; 95% CI: 1.01 to 1.3; p = 0.04) and tracheostomy (OR: 10.2; 95% CI: 3.2 to 32.1) p < 0.001). The predictive model forecasted dysphagia with a good ROC curve (AUC: 0.8; 95% CI: 0.7 to 0.9). CONCLUSIONS Dysphagia affects almost one-third of patients with SARS-COV-2 pneumonia requiring intubation in the ICU. The risk of developing dysphagia increases with prolonged mechanical ventilation, tracheostomy, and poorer prognosis on admission (worst APACHE II score).
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Viñas P, Martín-Martínez A, Alarcón C, Riera SA, Miró J, Amadó C, Clavé P, Ortega O. A Comparative Study between the Three Waves of the Pandemic on the Prevalence of Oropharyngeal Dysphagia and Malnutrition among Hospitalized Patients with COVID-19. Nutrients 2022; 14:nu14183826. [PMID: 36145215 PMCID: PMC9502091 DOI: 10.3390/nu14183826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The phenotype of patients affected by COVID-19 disease changed between the waves of the pandemic. We assessed the prevalence of oropharyngeal dysphagia (OD), malnutrition (MN), and mortality between the first three waves of COVID-19 patients in a general hospital. Methods: a prospective observational study between April 2020–May 2021. Clinical assessment for OD was made with the volume-viscosity swallowing test; nutritional assessment was performed consistent with GLIM criteria. A multimodal intervention was implemented in the second and third wave, including (a) texturized diets—fork mashable (1900 kcal + 90 g protein) or pureed (1700 kcal + 75 g protein), (b) oral nutritional supplements (500–600 kcal + 25–30 g protein), and (c) fluid thickening (250 mPa·s or 800 mPa·s). Results: We included 205 patients (69.3 ± 17.6 years) in the 1st, 200 (66.4 ± 17.5 years) in the 2nd, and 200 (72.0 ± 16.3 years;) in the 3rd wave (p = 0.004). On admission, prevalence of OD was 51.7%, 31.3% and 35.1%, and MN, 45.9%, 36.8% and 34.7%, respectively; mortality was 10.7%, 13.6% and 19.1%. OD was independently associated with age, delirium, and MN; MN, with age, OD, diarrhea and ICU admission; mortality, with age, OD and MN. (4) Conclusions: Prevalence of OD, MN and mortality was very high among COVID-19 patients. OD was independently associated with MN and mortality. An early and proactive multimodal nutritional intervention improved patients’ nutritional status.
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Affiliation(s)
- Paula Viñas
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Alberto Martín-Martínez
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Claudia Alarcón
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Stephanie A. Riera
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Jaume Miró
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Cristina Amadó
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93-741-77-00 (ext. 1046)
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
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19
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Holdiman A, Rogus-Pulia N, Pulia MS, Stalter L, Thibeault SL. Risk Factors for Dysphagia in Patients Hospitalized with COVID-19. Dysphagia 2022; 38:933-942. [PMID: 36109398 PMCID: PMC9483550 DOI: 10.1007/s00455-022-10518-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022]
Abstract
Patients hospitalized with COVID-19 may be at risk for dysphagia and vulnerable to associated consequences. We investigated predictors for dysphagia and its severity in a cohort of patients hospitalized with COVID-19 at a single hospital center. A large level I trauma center database was queried for all patients hospitalized with COVID-19. Demographics, medical information associated with COVID-19, specific to dysphagia, and interventions were collected. 947 patients with confirmed COVID-19 met the criteria. 118 (12%) were seen for a swallow evaluation. Individuals referred for evaluation were significantly older, had a lower BMI, more severe COVID-19, and higher rates of intubation, pneumonia, mechanical ventilation, tracheostomy placements, prone positioning, and ARDS. Pneumonia (OR 3.57, p = 0.004), ARDS (OR 3.57, p = 0.029), prone positioning (OR 3.99, p = 0.036), ventilation (OR 4.01, p = 0.006), and intubation (OR 4.75, p = 0.007) were significant risk factors for dysphagia. Older patients were more likely to have more severe dysphagia such that for every 1-year increase in age, the odds of severe dysphagia were 1.04 times greater (OR 1.04, p = 0.028). Patients hospitalized with COVID-19 are at risk for dysphagia. We show predictive variables that should be considered when referring COVID-19 patients for dysphagia services to reduce time to intervention/evaluation.
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Affiliation(s)
- Anna Holdiman
- Division of Otolaryngology, Department of Surgery, UW-Madison, 5103 WIMR, 1111 Highland Ave., Madison, WI, 53705, USA
| | - Nicole Rogus-Pulia
- Division of Geriatrics and Gerontology, Department of Medicine, UW-Madison, Madison, WI, USA
| | - Michael S Pulia
- Department of Emergency Medicine, UW-Madison, Madison, WI, USA
| | - Lily Stalter
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, UW-Madison, Madison, WI, USA
| | - Susan L Thibeault
- Division of Otolaryngology, Department of Surgery, UW-Madison, 5103 WIMR, 1111 Highland Ave., Madison, WI, 53705, USA.
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Fisher EW, Sandler D. Virtual issue: ENT care of older adults. J Laryngol Otol 2022; 136:785-787. [DOI: 10.1017/s0022215122001207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Silva CC, Bichara CNC, Carneiro FRO, Palacios VRDCM, Berg AVSVD, Quaresma JAS, Magno Falcão LF. Muscle dysfunction in the long coronavirus disease 2019 syndrome: Pathogenesis and clinical approach. Rev Med Virol 2022; 32:e2355. [PMID: 35416359 PMCID: PMC9111061 DOI: 10.1002/rmv.2355] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/20/2022] [Accepted: 04/01/2022] [Indexed: 01/08/2023]
Abstract
In long coronavirus disease 2019 (long COVID‐19), involvement of the musculoskeletal system is characterised by the persistence or appearance of symptoms such as fatigue, muscle weakness, myalgia, and decline in physical and functional performance, even at 4 weeks after the onset of acute symptoms of COVID‐19. Muscle injury biomarkers are altered during the acute phase of the disease. The cellular damage and hyperinflammatory state induced by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection may contribute to the persistence of symptoms, hypoxaemia, mitochondrial damage, and dysregulation of the renin‐angiotensin system. In addition, the occurrence of cerebrovascular diseases, involvement of the peripheral nervous system, and harmful effects of hospitalisation, such as the use of drugs, immobility, and weakness acquired in the intensive care unit, all aggravate muscle damage. Here, we review the multifactorial mechanisms of muscle tissue injury, aggravating conditions, and associated sequelae in long COVID‐19.
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Affiliation(s)
- Camilla Costa Silva
- Center for Biological and Health Sciences, State University of Para, Belém, Brazil
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22
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Clunie GM, Bolton L, Lovell L, Bradley E, Bond C, Bennington S, Roe J. Considerations for speech and language therapy management of dysphagia in patients who are critically ill with COVID-19: a single centre case series. International Journal of Therapy and Rehabilitation 2022. [DOI: 10.12968/ijtr.2021.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Patients treated with intubation and tracheostomy for COVID-19 infection are at risk of increased incidence of laryngeal injury, dysphagia and dysphonia. Because of the novelty of the SARS-CoV-2 virus, little is known about the type of dysphagia patients experience as a result of infection and critical illness. The aim of this case series report was to progress understanding of COVID-19 and dysphagia following admission to an intensive care unit and to guide speech and language therapy clinical practice in the ongoing pandemic. Methods A retrospective case review was conducted of all patients at Imperial College Healthcare NHS Trust, London who underwent a tracheostomy because of COVID-19 and received an instrumental assessment of swallowing in the early stages of the pandemic. Results A total of 11 patients were identified, and descriptive statistics were used to present demographic data, with a narrative account of their dysphagia profile used to describe presentation. Causes and presentation of dysphagia were heterogenous, with each patient requiring individualised clinical management to maximise outcome. A positive trend was seen in terms of recovery trajectory and progressing to oral intake. Conclusions This study reports on early experience of the presentation of dysphagia in patients with COVID-19 and demonstrates the value of instrumental assessment. It indicates the need for further research to consolidate knowledge and guide clinical practice.
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Affiliation(s)
- Gemma M Clunie
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lee Bolton
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Lindsay Lovell
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth Bradley
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Cara Bond
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Sarah Bennington
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Justin Roe
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Affiliation(s)
- L. White
- Institute of Inflammation and Ageing University of Birmingham Birmingham UK
| | - T. Jackson
- Institute of Inflammation and Ageing University of Birmingham Birmingham UK
- University Hospitals Birmingham NHS Foundation Trust Birmingham UK
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Shadi MS, Farahat M. Self-perceived dysphagia in non-invasively ventilated COVID-19 patients. Eur Arch Otorhinolaryngol 2022; 279:5929-37. [PMID: 35947148 DOI: 10.1007/s00405-022-07557-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/12/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE COVID-19 is known to present with a wide range of clinical symptoms. COVID-19-related dysphagia has been frequently investigated in patients who were critically ill and mechanically ventilated, but not in those with less severe presentations. This study aims to identify the frequency, characteristics, and severity of self-perceived oropharyngeal dysphagia in non-intubated COVID-19 patients. METHODS In this cross-sectional study, data were collected from patients using a self-administered questionnaire that included the Eating Assessment Tool (EAT-10). RESULTS The study included 359 participants with a median age of 34 (range: 18-65) years. Self-perceived dysphagia (EAT-10 total score > 2) was identified in 64.62%, and their median EAT-10 total score was 13 (range 3-40). The most prevalent symptoms were painful swallowing, affected pleasure of eating, stressful swallowing, and coughing while eating. Age, gender, and hospitalization were not statistically significantly associated with the presence of dysphagia, while re-infection, duration, and severity of COVID-19 diagnosis were. The EAT-10 total score was higher in moderate and severe COVID-19 cases as compared to mild cases, and showed a statistically significant inverse correlation with the duration of COVID-19 (r = - 0.267). CONCLUSION Self-perceived dysphagia was prevalent in non-intubated COVID-19 patients. Its severity was related to that of COVID-19 and its duration.
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Ward EC, Raatz M, Marshall J, Wishart LR, Burns CL. Telepractice and Dysphagia Management: The Era of COVID-19 and Beyond. Dysphagia 2022; 37:1386-1399. [PMID: 35428923 PMCID: PMC9012247 DOI: 10.1007/s00455-022-10444-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic drove rapid and widespread uptake of telepractice across all aspects of healthcare. The delivery of dysphagia care was no exception, with telepractice recognized as a service modality that could support social distancing/infection control, overcome service delivery challenges created by lockdowns/service closures, and address consumer concerns about attending in-person appointments. Now, almost two years since most services first rapidly deployed telepractice, it is time to reflect on the big picture, and consider how telepractice will continue as a service option that is sustained and integrated into mainstream dysphagia care. It is also timely to consider the research agenda needed to support this goal. To this end, in this paper we present 4 discussion topics, which raise key considerations for the current and future use of telepractice within adult and pediatric dysphagia services. These are (1) Dysphagia services must meet consumer and service needs; (2) Aspects of dysphagia services can be safely and reliably provided via telepractice; (3) Telepractice can be used in flexible ways to support the delivery of dysphagia services; and (4) Providing quality dysphagia services via telepractice requires planned implementation and evaluation. Then directions for future research are discussed. These considerations are presented to help shift perspectives away from viewing telepractice as simply a COVID-19 "interim-care solution". Rather, we encourage clinicians, services, and researchers to embrace a future of "integrated care", where traditional dysphagia services are combined with telepractice models, to enhance the quality of care provided to our clients.
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Affiliation(s)
- Elizabeth C. Ward
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, PO Box 6053, Buranda, QLD 4102 Australia ,School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
| | - Madeline Raatz
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,Speech Pathology Department, Queensland Children’s Hospital, Brisbane, QLD Australia
| | - Jeanne Marshall
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,Speech Pathology Department, Queensland Children’s Hospital, Brisbane, QLD Australia
| | - Laurelie R. Wishart
- Centre for Functioning and Health Research (CFAHR), Metro South Hospital and Health Service, PO Box 6053, Buranda, QLD 4102 Australia ,School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia
| | - Clare L. Burns
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD Australia ,Speech Pathology Department, Royal Brisbane & Women’s Hospital, Metro North Hospital and Health Service, Brisbane, QLD Australia
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Printza A, Tedla M, Frajkova Z, Sapalidis K, Triaridis S. Dysphagia Severity and Management in Patients with COVID-19. Curr Health Sci J 2021; 47:147-56. [PMID: 34765231 DOI: 10.12865/CHSJ.47.02.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/07/2021] [Indexed: 11/18/2022]
Abstract
COVID-19 has resulted in unprecedented numbers of patients treated at intensive care units (ICUs). Dysphagia is a key concern in critical illness survivors. We investigated the severity of dysphagia in COVID-19 and the need to adapt practices to provide efficient care. We reviewed the literature on COVID-19, post-critical-illness dysphagia, and dysphagia and tracheostomy guidelines during the pandemic. Critically ill COVID-19 patients present a high incidence of dysphagia, aggravated by respiratory distress, deconditioning, and neurological complications. Mechanical ventilation (MV), delirium, sedation and weakness are worse in COVID-19 than in other etiologies of critical care. In awake patients, respiratory compromise impairs breathing-swallowing-coughing coordination. Tracheostomy reduces laryngopharyngeal trauma, sedation, delirium, ICU stay and improves swallowing rehabilitation. Tracheostomy weaning and swallowing evaluation is complex in COVID-19 due to respiratory instability and a team discussion will guide adaptations. Patients assessed in the ICU were 67% recommended to be nil by mouth (were aspirating). Two months following hospital discharge, 83% of those who had undergone tracheostomy were managing a normal diet. Severely ill COVID-19 patients are expected to regain swallow function. Dysphagia care is based on adaptation of practices to the patients' multiple impairments.
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Regan J, Walshe M, Lavan S, Horan E, Murphy PG, Healy A, Langan C, Malherbe K, Murphy BF, Cremin M, Hilton D, Cavaliere J, Curley J, Moloney A, Flanagan G, Whyte A. Dysphagia, Dysphonia, and Dysarthria Outcomes Among Adults Hospitalized With COVID-19 Across Ireland. Laryngoscope 2021; 132:1251-1259. [PMID: 34622966 PMCID: PMC8662217 DOI: 10.1002/lary.29900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/15/2021] [Accepted: 10/05/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate the presence, degree, predictors, and trajectory of dysphagia, dysphonia, and dysarthria among adults hospitalized with COVID-19 across the Republic of Ireland (ROI) during the first wave of the pandemic. STUDY DESIGN Prospective observational cohort study. METHODS Adults with confirmed COVID-19 who were admitted into 14 participating acute hospitals across ROI and referred to speech and language therapy between March 1st and June 30th, 2020 were recruited. Outcomes obtained at initial SLT evaluation and at discharge were oral intake status (Functional Oral Intake Scale), perceptual voice quality (GRBAS), and global dysarthria rating (Dysarthria Severity Scale). RESULTS Data from 315 adults were analyzed. At initial SLT assessment, 84% required modified oral diets, and 31% required tube feeding. There were high rates of dysphonia (42%) and dysarthria (23%). History of intubation (OR 19.959, 95% CI 6.272, 63.513; P = .000), COVID-19 neurological manifestations (OR 3.592, 95% CI 1.733, 7.445; P = .001), and age (OR 1.034; 95% CI 1.002, 1.066; P = .036) were predictive of oral intake status. History of intubation was predictive of voice quality (OR 4.250, 95% CI 1.838, 9.827; P = .001) and COVID-19 neurological manifestations were predictive of dysarthria (OR 2.275; 95% CI 1.162, 4.456; P = .017). At discharge, there were significant improvements in oral intake (Z = -7.971; P = .000), voice quality (Z = -5.971; P = .000), and dysarthria severity (Z = -2.619; P = .009), although need for modified oral intake (59%), dysphonia (23%), and dysarthria (14%) persisted. CONCLUSION Dysphagia, dysphonia, and dysarthria were widespread among adults hospitalized with COVID-19 and they persisted for many at discharge. Prompt SLT evaluation is required to minimize complications. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Sarah Lavan
- Speech and Language Therapy Department, St. James' Hospital, Dublin, Ireland
| | - Eanna Horan
- Speech and Language Therapy Department, Tallaght University Hospital, Dublin, Ireland
| | - Patricia Gillivan Murphy
- Speech and Language Therapy Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Anne Healy
- Speech and Language Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Caoimhe Langan
- Speech and Language Therapy Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Karen Malherbe
- Speech and Language Therapy Department, Galway University Hospital, Galway, Ireland
| | - Breda Flynn Murphy
- Speech and Language Therapy Department, Midland Regional Hospital Tullamore & Portlaoise, Offaly, Ireland
| | - Maria Cremin
- Speech and Language Therapy Department, University Hospital Kerry, Kerry, Ireland
| | - Denise Hilton
- Speech and Language Therapy Department, Cavan General Hospital, Cavan, Ireland
| | - Jenni Cavaliere
- Speech and Language Therapy Department, University Hospital Waterford, Waterford, Ireland
| | - Jacinta Curley
- Speech and Language Therapy Department, Wexford General Hospital, Wexford, Ireland
| | - Andrea Moloney
- Speech and Language Therapy Department, St. Luke's Hospital, Kilkenny, Ireland
| | - Grace Flanagan
- Speech and Language Therapy Department, Sligo University Hospital, Sligo, Ireland
| | - Alice Whyte
- Speech and Language Therapy Department, Naas General Hospital, Kildare, Ireland
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Reyes-Torres CA, Flores-López A, Osuna-Padilla IA, Hernández-Cárdenas CM, Serralde-Zúñiga AE. Phase angle and overhydration are associated with post-extubating dysphagia in patients with COVID-19 discharged from the ICU. Nutr Clin Pract 2021; 37:110-116. [PMID: 34617311 PMCID: PMC8661566 DOI: 10.1002/ncp.10781] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Few studies have evaluated the prevalence of post‐extubation dysphagia and associated factors in patients with coronavirus disease 2019 (COVID‐19) . Our study assessed the prevalence of post‐extubation dysphagia and body composition in patients with COVID‐19 discharged from an intensive care unit (ICU). Methods A prospective cohort study was performed in post‐ICU extubated patients with acute respiratory distress syndrome related to COVID‐19 in two referral hospitals. A total of 112 patients were evaluated and included; swallowing assessment and bioelectrical impedance analysis (BIA) were performed after extubation and discharge from the ICU. To identify associations between dysphagia, lower phase angle (PhA) (<4.8°) and hydration (extracellular water/total body water < 0.390) logistic and linear regression analyses were conducted. Results The incidence of post‐extubation dysphagia was 41% (n = 46). From these, 65% (n = 30) had severe swallowing impairment. Overhydration and PhA were significantly different in patients with dysphagia, and segmental hydration in the trunk and legs was higher than in arms. PhA <4.8° (odds ratio [OR], 12.2; 95% CI, 4.3–34.1; P < .05) and overhydration measured by BIA (OR, 9.1; 95% CI, 3.4–24.5; P < .05) were associated with post‐extubation dysphagia in multivariate analysis. PhA (<4.8°) was associated with a lower rate of swallowing recovery at hospital discharge (log‐rank test = 0.007). Conclusions A high incidence of post‐extubation dysphagia was found in patients with COVID‐19. Low PhA and overhydration were associated with the presence of dysphagia. Lower PhA was an independent factor for swallowing recovery at discharge.
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Affiliation(s)
- Carlos A Reyes-Torres
- Servicio de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Adriana Flores-López
- Servicio de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Iván A Osuna-Padilla
- Departamento de Áreas Críticas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Carmen M Hernández-Cárdenas
- Departamento de Áreas Críticas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Aurora E Serralde-Zúñiga
- Servicio de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Langton-Frost N, Brodsky MB. Speech-language pathology approaches to neurorehabilitation in acute care during COVID-19: Capitalizing on neuroplasticity. PM R 2021; 14:217-226. [PMID: 34595841 PMCID: PMC8661644 DOI: 10.1002/pmrj.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 09/03/2021] [Accepted: 09/24/2021] [Indexed: 11/11/2022]
Abstract
Neurologic manifestations associated with a coronavirus disease 2019 (COVID‐19) diagnosis are common and often occur in severe and critically ill patients. In these patients, the neurologic symptoms are confounded by critical care conditions, such as acute respiratory distress syndrome (ARDS). Patients with dual diagnoses of COVID‐19 and neurologic changes such as myopathy, polyneuropathy, and stroke are likely at a higher risk of experiencing deficits with swallowing, communication, and/or cognition. Speech‐language pathologists are an integral part of both the critical care and neurologic disorders multi‐disciplinary teams, offering valuable contributions in the evaluation, treatment, and management of these areas. Patients in intensive care units (ICUs) who require mechanical ventilation often experience difficulty with communication and benefit from early speech‐language pathology intervention to identify the most efficient communication methods with the medical team and caregivers. Moreover, patients with neurologic manifestations may present with cognitive‐linguistic impairments such as aphasia, thereby increasing the need for communication‐based interventions. Difficulties with voice and swallowing after extubation are common, often requiring frequent treatment sessions, possibly persisting beyond ICU discharge. After leaving the ICU, patients with COVID‐19 often experience physical, cognitive, and mental health impairments collectively called post‐intensive care syndrome. This is often a lengthy road as they progress toward full recovery, requiring continued speech‐language pathology treatment after hospital discharge, capitalizing on the principles of neuroplasticity.
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Affiliation(s)
- Nicole Langton-Frost
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Martin B Brodsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, USA
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Abstract
In this review, we discuss the pathophysiologic and management aspects of acute sarcopenia in relation to SARS-CoV-2 infection. COVID-19 is as a multi-organ infectious disease characterized by a severe inflammatory and highly catabolic status, influencing the deep changes in the body build, especially the amount, structure, and function of skeletal muscles which would amount to acutely developed sarcopenia. Acute sarcopenia may largely impact patients’ in-hospital prognosis as well as the vulnerability to the post-COVID-19 functional and physical deterioration. The individual outcome of the COVID-19 and the degree of muscle mass and functional loss may be influenced by multiple factors, including the patient’s general pre-infection medical and functional condition, especially in older adults. This paper gathers the information about how the SARS-CoV-2 hyper-inflammatory involvement exacerbates the immunosenescence process, enhances the endothelial damage, and due to mitochondrial dysfunction and autophagy, induces myofibrillar breakdown and muscle degradation. The aftermath of these acute and complex immunological SARS-CoV-2-related phenomena, augmented by anosmia, ageusia and altered microbiota may lead to decreased food intake and exacerbated catabolism. Moreover, the imposed physical inactivity, lock-down, quarantine or acute hospitalization with bedrest would intensify the acute sarcopenia process. All these deleterious mechanisms must be swiftly put to a check by a multidisciplinary approach including nutritional support, early physical as well cardio-pulmonary rehabilitation, and psychological support and cognitive training. The proposed holistic and early management of COVID-19 patients appears essential to minimize the disastrous functional outcomes of this disease and allow avoiding the long COVID-19 syndrome.
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Affiliation(s)
- Karolina Piotrowicz
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego St., building I, 5th floor, 30-688, Kraków, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego St., building I, 5th floor, 30-688, Kraków, Poland.
| | | | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
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Ceruti S, Glotta A, Galli A, Biggiogero M, Bona G, Mauri R, Saporito A, Capdevila X. Dysphagic disorder in a cohort of COVID-19 patients: Evaluation and evolution. Ann Med Surg (Lond) 2021; 69:102837. [PMID: 34512968 DOI: 10.1016/j.amsu.2021.102837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 01/08/2023] Open
Abstract
Background COVID-19 is a multisystem disease complicated by respiratory failure requiring sustanined mechanical ventilation (MV). Prolongued oro-tracheal intubation is associated to an increased risk of dysphagia and bronchial aspiration. Purpose of this study was to investigate swallowing disorders in critically ill COVID-19 patients. Material and methods This was a retrospective study analysing a consecutive cohort of COVID-19 patients admitted to the Intensive Care Unit (ICU) of our hospital. Data concerning dysphagia were collected according to the Gugging Swallowing Screen (GUSS) and related to demographic characteristics, clinical data, ICU Length-Of-Stay (LOS) and MV parameters. Results From March 2 to April 30, 2020, 31 consecutive critically ill COVID-19 patients admitted to ICU were evaluated by speech and language therapists (SLT). Twenty-five of them were on MV (61% through endotracheal tube and 19% through tracheostomy); median MV length was 11 days. Seventeen (54.8%) patients presented dysphagia; a correlation was found between first GUSS severity stratification and MV days (p < 0.001), ICU LOS (p < 0.001), age (p = 0.03) and tracheostomy (p = 0.042). No other correlations were found. At 16 days, 90% of patients had fully recovered; a significant improvement was registered especially during the first week (p < 0.001). Conclusion Compared to non-COVID-19 patiens, a higher rate of dysphagia was reported in COVID-19 patients, with a more rapid and complete recovery. A systematic early SLT evaluation of COVID-19 patients on MV may thus be useful to prevent dysphagia-related complications.
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Halfpenny R, Stewart A, Carter A, Wyatt M, Jephson C, O'Dwyer E, Cavalli L. Dysphonia and dysphagia consequences of paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Int J Pediatr Otorhinolaryngol 2021; 148:110823. [PMID: 34237522 PMCID: PMC9754852 DOI: 10.1016/j.ijporl.2021.110823] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/15/2021] [Accepted: 06/29/2021] [Indexed: 01/15/2023]
Abstract
IMPORTANCE Paediatric inflammatory multisystem syndrome, temporally associated with SARS-CoV-2 (PIMS-TS) is a novel disease first identified in 2020. Recent cohort studies have described the complex presentation and symptomatology. This paper provides detailed description of the dysphagia and dysphonia symptoms, management, and outcome. OBJECTIVE To describe dysphagia and dysphonia in PIMS-TS. DESIGN Retrospective cohort study. SETTING Single tertiary and quaternary children's hospital. PARTICIPANTS All 50 children treated for paediatric multisystem inflammatory disease between April and June 2020 were included in this study. MAIN OUTCOME(S) AND MEASURE(S) Dysphonia: GRBAS Perceptual Severity Scores, Vocal Handicap Index scores and the Vocal Tract Discomfort Scale. Dysphagia: Functional Oral Intake Scale. RESULTS Fifty children met the diagnostic criteria for PIMS-TS. 33 (66%) were male. Median age was 10 years (range: 1-17). 36 (72%) were of Black, Asian or minority ethnic background. Nine (18%) required specialist assessment and management of dysphagia and/or dysphonia. Five (55%) were male with a median age of 9 years 7 months (range: 1-15 years). Symptoms typically resolved within three months. Two children presented with persisting dysphonia three months post-presentation. Neurological, inflammatory, and iatrogenic causes of dysphagia and dysphonia were identified. CONCLUSIONS AND RELEVANCE Dysphonia and dysphagia are present in children with PIMS-TS. Further data is required to understand pathophysiology, estimate incidence, and determine prognostic factors. This preliminary data highlights the need for dysphagia and dysphonia screening and timely referral for specialist, multidisciplinary assessment and treatment to ensure short-term aspiration risk is managed and long-term, functional outcomes are optimised.
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Affiliation(s)
- Rhiannon Halfpenny
- Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK; University College London, Gower Street, London, WC1E 6BT, UK.
| | - Alexandra Stewart
- Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK,University College London, Gower Street, London, WC1E 6BT, UK
| | - Alison Carter
- Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Michelle Wyatt
- Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | | | - Emma O'Dwyer
- Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Lesley Cavalli
- Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK,University College London, Gower Street, London, WC1E 6BT, UK
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Singer P. Nutritional and metabolic management of COVID-19 intensive care patients. J Intensive Med 2021; 1:31-34. [PMID: 36943801 PMCID: PMC7919505 DOI: 10.1016/j.jointm.2021.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 04/15/2023]
Abstract
Nutritional and metabolic disturbances are observed in patients critically ill with Coronavirus disease 19 (COVID-19) patients. The aim of this review is to describe these disturbances during the progression of the disease, from the pre-intubation phase through the ventilated condition to the post extubation phase. The analysis of new data describing the prevalence of malnutrition, the modifications in energy expenditure and body composition are guiding medical nutritional therapy to prevent patients from experiencing severe energy deficit and muscle loss. Rehabilitation may be extremely prolonged and therefore, nutrition is mandatory to decrease this recondition period. This review also comments on the European Society of Parenteral and Enteral Nutrition (ESPEN) nutritional statements.
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Regan J, Walshe M, Lavan S, Horan E, Gillivan Murphy P, Healy A, Langan C, Malherbe K, Flynn Murphy B, Cremin M, Hilton D, Cavaliere J, Whyte A. Post-extubation dysphagia and dysphonia amongst adults with COVID-19 in the Republic of Ireland: A prospective multi-site observational cohort study. Clin Otolaryngol 2021; 46:1290-1299. [PMID: 34197688 PMCID: PMC8444742 DOI: 10.1111/coa.13832] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/14/2021] [Accepted: 06/20/2021] [Indexed: 12/16/2022]
Abstract
Objectives This study aims to (i) investigate post‐extubation dysphagia and dysphonia amongst adults intubated with SARS‐COV‐2 (COVID‐19) and referred to speech and language therapy (SLT) in acute hospitals across the Republic of Ireland (ROI) between March and June 2020; (ii) identify variables predictive of post‐extubation oral intake status and dysphonia and (iii) establish SLT rehabilitation needs and services provided to this cohort. Design A multi‐site prospective observational cohort study. Participants One hundred adults with confirmed COVID‐19 who were intubated across eleven acute hospital sites in ROI and who were referred to SLT services between March and June 2020 inclusive. Main Outcome Measures Oral intake status, level of diet modification and perceptual voice quality. Results Based on initial SLT assessment, 90% required altered oral intake and 59% required tube feeding with 36% not allowed oral intake. Age (OR 1.064; 95% CI 1.018–1.112), proning (OR 3.671; 95% CI 1.128–11.943) and pre‐existing respiratory disease (OR 5.863; 95% CI 1.521–11.599) were predictors of oral intake status post‐extubation. Two‐thirds (66%) presented with dysphonia post‐extubation. Intubation injury (OR 10.471; 95% CI 1.060–103.466) and pre‐existing respiratory disease (OR 24.196; 95% CI 1.609–363.78) were predictors of post‐extubation voice quality. Thirty‐seven per cent required dysphagia intervention post‐extubation, whereas 20% needed intervention for voice. Dysphagia and dysphonia persisted in 27% and 37% cases, respectively, at hospital discharge. Discussion Post‐extubation dysphagia and dysphonia were prevalent amongst adults with COVID‐19 across the ROI. Predictors included iatrogenic factors and underlying respiratory disease. Prompt evaluation and intervention is needed to minimise complications and inform rehabilitation planning.
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Affiliation(s)
- Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Sarah Lavan
- Speech and Language Therapy Department, St. James' Hospital, Dublin, Ireland
| | - Eanna Horan
- Speech and Language Therapy Department, Tallaght University Hospital, Dublin, Ireland
| | - Patricia Gillivan Murphy
- Speech and Language Therapy Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Anne Healy
- Speech and Language Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Caoimhe Langan
- Speech and Language Therapy Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Karen Malherbe
- Speech and Language Therapy Department, Galway University Hospital, Galway, Ireland
| | - Breda Flynn Murphy
- Speech and Language Therapy Department, Midland Regional Hospital Tullamore & Portlaoise, Offaly, Ireland
| | - Maria Cremin
- Speech and Language Therapy Department, University Hospital Kerry, Tralee, Ireland
| | - Denise Hilton
- Speech and Language Therapy Department, Cavan General Hospital, Cavan, Ireland
| | - Jenni Cavaliere
- Speech and Language Therapy Department, University Hospital Waterford, Waterford, Ireland
| | - Alice Whyte
- Speech and Language Therapy Department, Naas General Hospital, Naas, Ireland
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Osbeck Sandblom H, Dotevall H, Svennerholm K, Tuomi L, Finizia C. Characterization of dysphagia and laryngeal findings in COVID-19 patients treated in the ICU-An observational clinical study. PLoS One 2021; 16:e0252347. [PMID: 34086717 PMCID: PMC8177545 DOI: 10.1371/journal.pone.0252347] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/12/2021] [Indexed: 12/19/2022] Open
Abstract
Background Dysphagia appears to be common in patients with severe COVID-19. Information about the characteristics of dysphagia and laryngeal findings in COVID-19 patients treated in the intensive care unit (ICU) is still limited. Objectives The aim of this study was to evaluate oropharyngeal swallowing function and laryngeal appearance and function in patients with severe COVID-19. Method A series of 25 ICU patients with COVID-19 and signs of dysphagia were examined with fiberendoscopic evaluation of swallowing (FEES) during the latter stage of ICU care or after discharge from the ICU. Swallowing function and laryngeal findings were assessed with standard rating scales from video recordings. Results Pooling of secretions was found in 92% of patients. Eleven patients (44%) showed signs of silent aspiration to the trachea on at least one occasion. All patients showed residue after swallowing to some degree both in the vallecula and hypopharynx. Seventy-six percent of patients had impaired vocal cord movement. Erythema of the vocal folds was found in 60% of patients and edema in the arytenoid region in 60%. Conclusion Impairment of oropharyngeal swallowing function and abnormal laryngeal findings were common in this series of patients with severe COVID-19 treated in the ICU. To avoid complications related to dysphagia in this patient group, it seems to be of great importance to evaluate the swallowing function as a standard procedure, preferably at an early stage, before initiation of oral intake. Fiberendoscopic evaluation of swallowing is preferred due to the high incidence of pooling of secretion in the hypopharynx, silent aspiration, and residuals. Further studies of the impact on swallowing function in short- and long-term in patients with COVID-19 are warranted.
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Affiliation(s)
- Hanna Osbeck Sandblom
- Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Dotevall
- Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Svennerholm
- Department of Anaesthesiology and Intensive Care Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Affiliation(s)
- S Wallace
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - B A McGrath
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,University of Manchester Academic Critical Care, Wythenshawe Hospital, Manchester, UK
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Chadd K, Moyse K, Enderby P. Impact of COVID-19 on the Speech and Language Therapy Profession and Their Patients. Front Neurol 2021; 12:629190. [PMID: 33679590 PMCID: PMC7930219 DOI: 10.3389/fneur.2021.629190] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction: The UK's response to the COVID-19 pandemic presented multiple challenges to healthcare services including the suspension of non-urgent care. The impact on neurorehabilitation professions, including speech and language therapy (SLT), has been substantial. Objectives: To review the changes to SLT services triggered by the COVID-19 pandemic with respect to referral rates, service delivery and outcomes, as well as examining the contribution of SLTs to the neurorehabilitation of COVID-19 patients. Methods: Two surveys were distributed to Royal College of Speech and Language Therapists (RCSLT) members exploring experiences of service provision at 6 weeks and 22 weeks after the pandemic was declared in the UK. Responses to closed-ended questions, including questions regarding referral numbers were analyzed descriptively and compared at the two time-points. A database comprising routine clinical data from SLT services across the UK was used to compare information on patients receiving services prior to and during the pandemic. Data on COVID-19 patients was extracted, and findings are provided descriptively. Results: Referrals to SLT services during the acute COVID-19 period in the UK were substantially less than in the same period in 2019. A number of service changes were common including adopting more flexible approaches to provision (such as tele-therapy) and being unable to provide services to some patients. Database analysis suggests fewer patients have accessed SLT since the pandemic began, including a reduction in neurorehabilitation patients. For those who received SLT, the outcomes did not change. SLTs supported a range of needs of COVID-19 patients. Treatment outcomes for COVID-19 patients with dysphagia were positive. Discussion: The pandemic has affected neurorehabilitation and SLT services broadly: referral patterns are different, usual care has been disrupted and interventions have been modified affecting the impact on patient outcomes both positively and negatively. Some patients with COVID-19 require and benefit from SLT intervention.
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Affiliation(s)
- Katie Chadd
- Research and Outcomes, Royal College of Speech and Language Therapists, London, United Kingdom
| | - Kathryn Moyse
- Research and Outcomes, Royal College of Speech and Language Therapists, London, United Kingdom
| | - Pam Enderby
- Health Services Research, The University of Sheffield, Sheffield, United Kingdom
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