Characterization of dysphagia and laryngeal findings in COVID-19 patients treated in the ICU—An observational clinical study

Abstract

Background Dysphagia appears to be common in patients with severe COVID-19. Information about the characteristics of dysphagia and laryngeal findings in COVID-19 patients treated in the intensive care unit (ICU) is still limited. Objectives The aim of this study was to evaluate oropharyngeal swallowing function and laryngeal appearance and function in patients with severe COVID-19. Method A series of 25 ICU patients with COVID-19 and signs of dysphagia were examined with fiberendoscopic evaluation of swallowing (FEES) during the latter stage of ICU care or after discharge from the ICU. Swallowing function and laryngeal findings were assessed with standard rating scales from video recordings. Results Pooling of secretions was found in 92% of patients. Eleven patients (44%) showed signs of silent aspiration to the trachea on at least one occasion. All patients showed residue after swallowing to some degree both in the vallecula and hypopharynx. Seventy-six percent of patients had impaired vocal cord movement. Erythema of the vocal folds was found in 60% of patients and edema in the arytenoid region in 60%. Conclusion Impairment of oropharyngeal swallowing function and abnormal laryngeal findings were common in this series of patients with severe COVID-19 treated in the ICU. To avoid complications related to dysphagia in this patient group, it seems to be of great importance to evaluate the swallowing function as a standard procedure, preferably at an early stage, before initiation of oral intake. Fiberendoscopic evaluation of swallowing is preferred due to the high incidence of pooling of secretion in the hypopharynx, silent aspiration, and residuals. Further studies of the impact on swallowing function in short- and long-term in patients with COVID-19 are warranted.

Dysphagia in non-intubated patients affected by COVID-19 infection

“…In this context, patients affected by COVID-19 are assumed to be at high risk of developing swallowing disorder but data available on the characteristics and incidence of swallowing disorders associated with COVID-19 are still scarce. Although it has been demonstrated that intubated COVID-19 patients have dysphagia symptoms that persist after hospital discharge [ 10 , 11 ], we noticed during our daily clinical activity that also non-intubated SARS-CoV-2 patients could complain various grades of deglutition impairment and show symptoms of dysphagia. However, literature lacks of studies analyzing and trying to unfold the pathophysiologic features of dysphagia in this specific population represented by non-intubated COVID-19 patients.…”

Inflammatory Profiles of Tracheal Biopsies From SARS-CoV-2 Patients

“…As a matter of fact, they identified viral particles in the tracheal epithelium of 12 autopsies. Moreover, other authors reported laryngotracheal oedema that might suggest virus-mediated inflammation ( McGrath et al, 2020 ; Oliver et al, 2020 ; Osbeck Sandblom et al, 2021 ). For these reasons, the aim of this study was to identify the virus particles in the tracheal epithelium of live COVID-19 patients and to evaluate any histological and genetic differences compared to a control group.…”

Outcomes of critically ill COVID-19 survivors and caregivers: a case study-centred narrative review

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