Dysphagia presentation and management following coronavirus disease 2019: an acute care tertiary centre experience

Dawson, Camilla; Capewell, R; Ellis, Steve; Matthews, Sue; Adamson, Sheena; Wood, Martin; Fitch, Lily; Reid, Kimone Racquel Yolanda; Shaw, Mairead; Wheeler, Jennifer; Pracy, Paul; Nankivell, Paul; Sharma, Naveen

doi:10.1017/s0022215120002443

Cited by 67 publications

(134 citation statements)

References 11 publications

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“…As the spread of the virus accelerated and hospitalizations surged, thus did the demand for SLTs to be part of the team managing critically ill COVID-19 patients. Dysphagia (an impairment in swallowing function) emerged as a frequent complication in such patients with estimates of around 30% of those admitted to hospital with COVID-19 needing a swallow assessment ( 10 ), and many who were intubated requiring swallow rehabilitation ( 11 ). Not only does an impairment in swallow function result in difficulties with oral feeding, but it is also a risk factor for developing aspiration pneumonia, which has also been documented in COVID-19 patients ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on the Speech and Language Therapy Profession and Their Patients

2021

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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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Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on the Speech and Language Therapy Profession and Their Patients

2021

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“…Post-extubation dysphagia (PED) and dysphonia are common post-extubation in critical care patients (1)(2)(3)(4). Iatrogenic causes include prolonged intubation (5) and intubation injury including laryngeal oedema, granulations, ulceration and vocal cord immobility (6).…”

Section: Introductionmentioning

confidence: 99%

Post-Extubation Dysphagia and Dysphonia amongst Adults with COVID-19 in the Republic of Ireland: a Prospective Multi-Site Observational Cohort Study

Regan

Walshe

Lavan

et al. 2021

Preprint

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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: 100 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% unable for 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 percent required dysphagia rehabilitation post-extubation whereas 20% needed voice rehabilitation. 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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“…After prolonged intubation, swallowing problems and dysphagia occur and limit oral nutrient intake. Two hundred and eight patients were assessed for dysphagia, (102 post ICU patients of which 82 were tracheostomized) ( 32 ). The time from extubation to oral intake was 5.3 +/- 2.3 days and from tracheostomy to oral intake 14.8 +/- 6.6 days.…”

Section: Nutritional Management In Icu Patients Infected With Sars-comentioning

confidence: 99%

Nutritional and metabolic management of COVID-19 intensive care patients

Singer

2021

Journal of Intensive Medicine

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Nutritional and metabolic disturbances are observed in critically ill COVID 19 patients. The aim of this review is to describe these disturbances during the progression of the disease, from the pre intubation through the ventilated condition to the post extubation phase. Analysis of new data describing the prevalence of malnutrition, the modifications in energy expenditure and body composition are guiding medical nutritional therapy to prevent from severe energy deficit and muscle loss. Rehabilitation may be very prolonged and therefore, nutrition is mandatory to decrease this recondition period. This review comments also on the ESPEN nutritional statements.

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Dysphagia presentation and management following coronavirus disease 2019: an acute care tertiary centre experience

Cited by 67 publications

References 11 publications

Impact of COVID-19 on the Speech and Language Therapy Profession and Their Patients

Impact of COVID-19 on the Speech and Language Therapy Profession and Their Patients

Post-Extubation Dysphagia and Dysphonia amongst Adults with COVID-19 in the Republic of Ireland: a Prospective Multi-Site Observational Cohort Study

Nutritional and metabolic management of COVID-19 intensive care patients

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