Characteristics of postintubation dysphagia in ICU patients in the context of the COVID-19 outbreak: A report of 920 cases from a Brazilian reference center

Abstract

The purpose of this research was to identify risk factors that were independently related to the maintenance of a swallowing dysfunction in patients affected by critical COVID-19. We conducted a prospective observational cohort study of critical patients with COVID-19, who were admitted to a COVID-19 dedicated intensive care unit (ICU) and required prolonged orotracheal intubation (≥48 hours). Demographic and clinical data were collected at ICU admission and/or at hospital discharge or in-hospital death. Swallowing data was based on The Functional Oral Intake Scale (FOIS) and was collected at two distinct moments: initial swallowing assessment and at patient outcome. Patients were divided into two groups according to their FOIS level assigned on the last swallowing assessment: in-hospital resolved dysphagia–patients with FOIS levels 6 and 7; non-resolved dysphagia at hospital outcome–patients with FOIS levels 1 to 5. Nine hundred and twenty patients were included in our study. Results of the multivariate logistic regression model for the prediction of non-resolved dysphagia at hospital outcome in critical COVID-19 patients. indicated that increasing age (p = 0.002), severity at admission (p = 0.015), body mass index (p = 0.008), use of neuromuscular blockers (p = 0.028), presence of neurologic diseases (p = 0.038), presence of Diabetes Mellitus (p = 0.043) and lower FOIS levels on the initial swallowing assessment (p<0.001) were associated with higher chances of presenting dysphagia at hospital outcome. Critical patients with COVID-19 may experience post-acute COVID-19 dysphagia, indicating the need to prepare for the care/rehabilitation of these patients.

Risk factors independently associated with the maintenance of severe restriction of oral intake and alternative feeding method indication at hospital outcome in patients after acute ischemic stroke

“…Age-related atrophy of the soft tissues of the pharynx and larynx may also be considered a contributing factor to swallowing changes. 28 Considering stroke, studies have already described that increasing age is a strong predictive factor for a stronger and faster loss of muscle activities, increasing the incidence of dysphagia and mortality. 8 , 10 , 29 The present results show that both groups were composed of elderly patients but G1 had older participants, while G1 had a mean age of 72.9 years G2 had a mean age of 65.3.…”

Functional Recovery and Nutrition Management among Severe COVID-19 Cases during Post-extubation Hospitalization: A Case Series

“…The prevalence of PED among patients with COVID-19 is similar to that stated in previous reports (22.4%–100%). 4 , 5 , 6 , 7 , 23 , 24 , 25 )…”

“…The prevalence of PED among patients with COVID-19 is similar to that stated in previous reports (22.4%-100%). [4][5][6][7][23][24][25] Our results demonstrated that during the post-extubation period, daily median caloric and protein intakes increased from 6.9 kcal/kg per day (IQR, 3.5-10.2 kcal/kg per day) and 0.3 g/kg per day (IQR, 0.1-0.5 g/kg per day) at first BSE to 24.8 kcal/kg per day (IQR, 20.1-27.9 kcal/kg per day) and 1.1 g/kg per day (IQR, 0.9-1.2 g/kg per day), respectively, just before discharge. However, six patients showed caloric intakes that were less than 25 kcal/kg per day just before discharge.…”

“…Post-extubation dysphagia (PED) caused by prolonged intubated mechanical ventilation has been considered an important sequela among patients with severe COVID-19. 4 , 5 , 6 , 7 ) To minimize the potential clinical complications of PED, such as aspiration pneumonia and malnutrition, functional recovery from this swallowing disorder requires prompt evaluation and management of dysphagia by an interdisciplinary team, including a speech and language pathologist (SLP), a dietitian, and other medical staff. Optimal caloric and protein intakes are also necessary to enhance recovery of functional muscle mass and to prevent further loss, but patients are at risk of reductions in caloric and protein intakes after cessation of enteral nutrition and removal of the feeding tube.…”

“…3) Post-extubation dysphagia (PED) caused by prolonged intubated mechanical ventilation has been considered an important sequela among patients with severe COVID-19. [4][5][6][7] To minimize the potential clinical complications of PED, such as aspiration pneumonia and malnutrition, functional recovery from this swallowing disorder requires prompt…”