A Consensus Statement for the Management and Rehabilitation of Communication and Swallowing Function in the ICU: A Global Response to COVID-19

Abstract

Objective To identify core practices for workforce management of communication and swallowing functions in COVID-19 positive patients within the ICU. Design A modified Delphi methodology was utilized, with 3 electronic voting rounds. AGREE II and an adapted COVID-19 survey framework from physiotherapy were used to develop survey statements. Sixty-six statements pertaining to workforce planning and management of communication and swallowing function in the ICU were included. Setting Electronic modified Delphi process. Participants 35 speech-language pathologists (SLPs) from 6 continents representing 12 countries. Interventions Not applicable. Main Outcome Measures The main outcome was consensus agreement, defined a priori as ≥70% of participants with a mean Likert score ≥7.0 (11-point scale: “0” = strongly disagree, “10” strongly agree). Prioritization rank order of statements in a 4 th round was also conducted. Results SLPs with a median of 15 years ICU experience, working primarily in clinical (54%), in academic (29%) or managerial (17%) positions, completed all voting rounds. After the third round, 64 statements (97%) met criteria. Rank ordering identified issues of high importance. Conclusions A set of global consensus statements to facilitate planning and delivery of rehabilitative care for patients admitted to the ICU during the COVID-19 pandemic were agreed by an international expert SLP group. Statements focus on considerations for workforce preparation, resourcing and training, and the management of communication and swallowing functions. These statements support and provide direction for all members of the rehabilitation team to use for patients admitted to the ICU during a global pandemic.

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

“…The number of adults receiving SLT rehabilitation during hospital stay appeared low in this study and some adults did not receive dysphagia and dysphonia intervention when indicated. Concerns regarding aerosol generated procedures as well as lack of instrumental evaluations may have influenced the amount and type of intervention being offered during the first pandemic wave (16). Other influencing factors may be access to personal protective equipment, SLT services in ICU settings across ROI, and local dysphagia training.…”

“…FEES was not available in ICU settings during the first wave of the pandemic due to concerns regarding transmission risk (16). FEES provides physiological data on secretions, pharyngeal sensation and aspiration or residue.…”

“…The impact of intubation as part of COVID-19 management on swallowing and voice is unclear internationally, as are the dysphagia and dysphonia rehabilitation needs within this population (16). This study aims to characterise the presence and degree of post-extubation voice and swallowing difficulties amongst adults requiring intubation as part of medical management of COVID-19 in the Republic of Ireland (ROI) during the first wave of the pandemic.…”

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

“…Some questions remain as to the extent of late swallowing complications, potentially arising from virus-induced bulbar nerve damage ( 14 ) which may highlight the need for ongoing intervention. Thus, SLTs are an integral part of the intensive care unit team ( 15 ) and the longer-term rehabilitation team. Moreover, SLTs have a role in the management of dysphonia, another frequently reported symptom of the virus, reported in patients with mild to moderate COVID-19 ( 16 ).…”

Establishing Clinical Swallowing Assessment Services via Telepractice: A Multisite Implementation Evaluation

“…Since the onset of COVID-19, delivering CSEs via telepractice has been a model now recommended for use to minimize infection risk and enable the initial provision of dysphagia assessment services for patients with COVID-19 (Blumenfeld et al, 2020;Fong et al, 2020;Freeman-Sanderson et al, 2020;Ku et al, 2020;Malandraki et al, 2021;Mattei et al, 2020;Miles et al, 2021;Soldatova et al, 2020). However, although the last year has seen many more speech-language pathologists using this model to help manage patients and deliver services impacted by COVID, the original drivers for implementing CSEs via telepractice still remain.…”