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 ¼ 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).

BACKGROUND. Severe SARS-CoV-2 pneumonia has brought intensive care units (ICUs) and the consequences of prolonged hospitalisation, such as dysphagia, into focus.METHODS. Study population: Patients with severe pneumonia due to SARS-CoV-2 who required admission to critical units from March to June 2020. Dysphagia diagnostic method: Modified Viscosity Volume Swallowing Test (mV-VST). Objectives. To identify risk factors for dysphagia in patients with severe SARS-CoV-2 pneumonia requiring invasive mechanical ventilation and determine their incidence. Statistical analysis: Descriptive analysis of means or medians according to the normality of quantitative variables and proportions for the descriptive variables (95% CI). Univariate analysis of dysphagia using simple logistic regression. Multivariate analysis and construction of a predictive model for dysphagia using logistic regression.RESULTS. Descriptive analysis. Sample size: 232 patients; 72% (167) required intubation. Of these, 65.9% (110) survived and 84.5% (93) underwent the mV-VST, which diagnosed 26.9% (25) with dysphagia. Age: 60.5 years (95% CI: 58.5 to 61.9). Men: 74.1% (95% CI: 68.1 to 79.4). APACHE II score: 17.7 (95% CI: 13.3 to 23.2). Mechanical ventilation: 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). Overall mortality: 25.9% (95% CI: 20.6 to 31.9). Mortality in intubated patients: 34.1% (95% CI: 27.3 to 41.7). No patient diagnosed with dysphagia died. Univariate analysis. APACHE II, prone position, days of mechanical ventilation and need for tracheostomy, respiratory infection, kidney failure developed during admission and length of ICU and hospital stay were significantly associated (p<0.05) with dysphagia. Multivariate analysis. Dysphagia is independently explained by 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 resulting predictive model predicts dysphagia with a good ROC curve (AUC: 0.8; 95% CI: 0.7 to 0.9)CONCLUSIONS. Dysphagia affects almost one-third of patients, and the risk of developing dysphagia increases with prolonged mechanical ventilation, tracheostomy and greater severity on admission (APACHE II score).

Background: The present research aimed to evaluate the effect on outcomes of immunonutrition (IMN) enteral formulas during the intensive care unit (ICU) stay. Methods: A multicenter prospective observational study was performed. Patient characteristics, disease severity, nutritional status, type of nutritional therapy and outcomes, and laboratory parameters were collected in a database. Statistical differences were analyzed according to the administration of IMN or other types of enteral formulas. Results: In total, 406 patients were included in the analysis, of whom 15.02% (61) received IMN. Univariate analysis showed that patients treated with IMN formulas received higher mean caloric and protein intake, and better 28-day survival (85.2% vs. 73.3%; p = 0.014. Unadjusted Hazard Ratio (HR): 0.15; 95% CI (Confidence Interval): 0.06–0.36; p < 0.001). Once adjusted for confounding factors, multivariate analysis showed a lower need for vasopressor support (OR: 0.49; 95% CI: 0.26–0.91; p = 0.023) and continuous renal replacement therapies (OR: 0.13; 95% CI: 0.01–0.65; p = 0.049) in those patients who received IMN formulas, independently of the severity of the disease. IMN use was also associated with higher protein intake during the administration of nutritional therapy (OR: 6.23; 95% CI: 2.59–15.54; p < 0.001), regardless of the type of patient. No differences were found in the laboratory parameters, except for a trend toward lower triglyceride levels (HR: 0.97; 95% CI: 0.95–0.99; p = 0.045). Conclusion: The use of IMN formulas may be associated with better outcomes (i.e., lower need for vasopressors and continuous renal replacement), together with a trend toward higher protein enteral delivery during the ICU stay. These findings may ultimately be related to their modulating effect on the inflammatory response in the critically ill. NCT Registry: 03634943.