Background: At present, the flexible endoscopic evaluation of swallowing (FEES) is one of the most commonly used methods for the objective assessment of swallowing. This multicenter trial prospectively collected data on the safety of FEES and also assessed the impact of this procedure on clinical dysphagia management. Methods: Patients were recruited in 23 hospitals in Germany and Switzerland from September 2014 to May 2017. Patient characteristics, professional affiliation of the FEES examiners (physicians or speech and language therapists), side-effects and cardiorespiratory parameters, severity of dysphagia and clinical consequences of FEES were documented. Results: 2401 patients, mean age 69.8 (14.6) years, 42.3% women, were included in the FEES-registry. The most common main diagnosis was stroke (61%), followed by Parkinson's disease (6.5%). FEES was well tolerated by patients. Complications were reported in 2% of examinations, were all self-limited and resolved without sequelae and showed no correlation to the endoscopist's previous experience. In more than 50% of investigations FEES led to changes of feeding strategies, in the majority of cases an upgrade of oral diet was possible. Discussion: This study confirmed that FEES, even when performed by less experienced clinicians is a safe and well tolerated procedure and significantly impacts on the patients' clinical course. Implementation of a FEES-service in different clinical settings may improve dysphagia care. Trial registration: ClinicalTrials.gov NCT03037762, registered January 31st 2017.
ZusammenfassungWährend pneumologische, kardiovaskuläre und neurologische Komplikationen einer SARS-CoV-2-Infektion schon gut erforscht sind, ist über Einflüsse auf das muskulo-skelettale System bisher noch relativ wenig bekannt.Vorgestellt wird ein 65-jähriger Patient, der eine Humeruskopffraktur erlitt, die konservativ behandelt wurde. Sechs Wochen nach dem Unfallereignis traten Husten und Fieber auf, und es wurde COVID-19 diagnostiziert. Es entwickelte sich ein schwerer Verlauf mit ARDS, Lungenarterienembolien, multiplen Hirninfarkten und Hemiparese links, der eine mehrwöchige Beatmung erforderlich machte. In der Folge bildeten sich ausgeprägte Ossifikationen im Bereich der linken Schulter und des linken Ellenbogens aus.Heterotope Ossifikationen nach Schädel-Hirn-Traumen, nach Verletzungen des Rückenmarks oder längerfristiger Beatmung sind bekannt. Zur Beantwortung der Frage, ob die heterotopen Ossifikationen durch proinflammatorische Prozesse im Rahmen der Immobilisierung und Beatmung oder durch noch unbekannte Pathomechanismen direkt durch SARS-CoV-2 entstanden sind, besteht noch Forschungsbedarf.
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