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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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