Dysphagia, Dysphonia, and Dysarthria Outcomes Among Adults Hospitalized With COVID‐19 Across Ireland

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%).

Speech-Language Pathology Management for Adults with COVID-19 in the Acute Hospital Setting: What Do We Know?

“…At the title and abstract review stage, the kappa coefficient was 0.81 and at the full article review stage the kappa coefficient was 0.90. As can be seen in Table 2, 17 out of the 54 publications provided empirical data [5,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Most evidence was either Level IV (well-designed case-control or cohort studies) or VI (case study) and a grade of 'B' when applying the American Society of Plastic Surgeons grade recommendation scale for evidence-based clinical practice guidelines [26], meaning that empirical evidence is available and findings are consistent, but clinicians should remain alert to new information and patient preferences.…”

“… With intensive therapy, most patients can regain normal swallow function following COVID-19. In a study conducted in the Republic of Ireland, Regan and colleagues [20] reported that postextubation, 90% of patients referred for a dysphagia assessment required altered oral intake, 36% were not allowed oral intake and 59% required tube feeding. In their analysis, age, proning and preexisting respiratory disease were predictors of oral intake status post-extubation.…”

“…Table 5 Publications included in the review that contained empirical data mapped to initial involvement recommendations for practice with patients with COVID-19 covered by Namasivayam-MacDonald and Riquelme [6] 2.4 Outside of the ICU, SLPs should conduct clinical swallow evaluations on patients with COVID-19 only when they have stable vitals signs and acceptable respiratory status 2.5 SLPs should remain aware of the duration of close contact to help limit contact Rouhani, 2021 [22]; Traugott, 2021 [25] 2.6 During direct clinical swallow evaluations, SLPs should avoid testing a volitional cough and the gag reflex. SLPs should also minimize the number of medical devices and other reusable equipment that are exposed to infected patients during assessments Cavalagi, 2020 [16]; Sandblom, 2021 [23] 2.7 SLPs should work with nursing staff, as per usual practice, to establish and carry out an oral care plan Ishkanian, 2021 [11]; Rouhani, 2021 [22]; Stierli, 2020 [24] 2.8 In the absence of adequate PPE (i.e., N95 masks or the equivalent), SLPs may consider the use of telepractice to facilitate direct clinical swallow evaluations Kearney, 2021 [5] 2.9 SLPs should undertake a point-of-care risk assessment to determine need and appropriateness for videofluorscopic swallowing studies 2.10 Given that it is an AGP, SLPs should avoid performing all SLPled endoscopic procedures, including FEES, videostroboscopy, and manometry, on patients with confirmed COVID-19 unless necessary Boggiano, 2021 [15]; Cavalagi, 2020 [16]; Dawson, 2020 [10]; Kearney, 2021 [5]; Regan, 2022 [20]; Sandblom, 2021 [23]; Traugott, 2021 [25] 2.11 SLPs should clean all equipment after each use with facilitydesignated disinfectants and minimize use of adjunct tools Cavalagi, 2020 [16]; Sandblom, 2021 [23] 2.12 SLPs should reevaluate their approach to service delivery and perform a point-of-care risk assessment for every patient interaction 2.13 If any clinical procedures are modified as part of a risk management approach to the COVID-19 pandemic, document this clearly in the health record Active SLP involvement (i.e., management of communication and swallowing difficulties) was also commonly covered by all articles included in the review, with the only topics not being covered being end-of-life care for patients with COVID-19 (recommendation 3.8) and the documentation of modifications to clinical procedures (recommendation 3.11). As can be ascertained from Table 6, 12 out of 17 (71%) articles with empirical data [5,…”

“…Studies Supporting Recommendation 3.1 Involvement with patients with possible dysphagia postextubation Boggiano, 2021 [15]; Dawson, 2020 [10]; Lima, 2020 [19]; Regan, 2022 [20]; Regan, 2021 [21]; Sandblom, 2021 [23]; Stierli, 2020 [24]; Traugott, 2021 [25] 3.2 Involvement with patients with possible dysphagia in the presence of respiratory compromise Ishkanian, 2021 [11]; Sandblom, 2021 [23] 3.3 Involvement with patients with possible dysphagia upon decompensation Boggiano, 2021 [15]; Ishkanian, 2021 [11] 3.4 Involvement with patients who show signs of cognitive difficulties and inability to communicate basic needs Bellinger, 2021 [14] 3.5 Involvement with patients who require augmentative and alternative communication equipment 3.6 Involvement with patients with tracheostomies with/without mechanical ventilation Boggiano, 2021 [15]; Dawson, 2020 [10]; Rouhani, 2021 [22]; Sandblom, 2021 [23]; Stierli, 2020 [24] 3.7 Involvement with patients with laryngectomies with/without mechanical ventilation Rouhani, 2021 [22]; Stierli, 2020 [24] 3.8 Involvement with patients who require end of life care 3.9 When rehabilitation cannot take place due to limited in-person rehabilitation options during the pandemic and/or when deconditioning may impact the swallow, SLPs should consider providing swallowing maintenance exercises to patients Regan, 2022 [20] 3.10 SLPs should consider using telepractice to provide rehabilitation to outpatients with swallowing and/or communication impairments Kearney, 2021 [5]; Regan, 2022 [20] 3.11 If any clinical procedures are modified as part of a risk management approach to the COVID-19 pandemic, document this clearly in the health record PPE recommendations were provided in almost one third (17 out of 54; 31%) of all publications [28, 29, 31-33, 40, 46, 51, 53, 54, 56-58, 61, 62, 64], but PPE was not explicitly discussed with supporting evidence in any of the articles reporting empirical data. Suggestions for integration of AAC devices, whether they be low or high technology, were only discussed in five publications [27,31,32,…”

Reoralisierung nach Intubation bei Intensivaufenthalt

“…Bei schweren Verläufen von Coronavirus-Erkrankungen 2019 (COVID) kann es neben den bekannten die Atmung betreffenden Komplikationen auch zu erheblichen Stimm- und Schluckstörungen kommen (zum Beispiel Critical-illness-Dysphagie oder Post-Extubations-Dyphagie) [ 1 – 3 ].…”