Proposing a Multisystem Swallowing Framework: A Network Medicine Approach in the Era of COVID-19

Abstract

Purpose: Swallowing impairments (dysphagia) following severe COVID-19 are complex, as is recovery from the disease itself. Like other critical illnesses, dysphagia management requires multidisciplinary involvement owing to the interaction between numerous physiological systems. Our objectives are to (a) propose a literature-based network medicine framework highlighting multisystem considerations for dysphagia management following critical illness including COVID-19 and (b) discuss clinician innovation and the evolution of dysphagia practice during a global pandemic. Method: A literature search identified current and relevant studies in areas pertinent to speech-language pathologists caring for patients with COVID-19. Our tutorial presents a network medicine framework of critical illness dysphagia and its “phenotypic” presentation with application to COVID-19. We also consider the individual and collective burden of the illness and global pandemic. Results: Iatrogenic and complex pathophysiologies likely contribute to dysphagia during critical illness. Upper aerodigestive tract functions, specifically swallowing, rely upon multiple systems for safe execution. Critical illness comorbidities, particularly respiratory challenges and supportive ventilation, are features of COVID-19 often exacerbating dysphagia risk. Throughout the pandemic, increased demands on and reallocation of resources have led to clinical adaptations across settings and placed significant burden on those who deliver care. Conclusions: Care provision for patients with COVID-19 relies on dynamic knowledge about disease mechanisms and effective interventions. Dysphagia management should employ a multidisciplinary and multisystem approach. Together, clinicians and health care systems should endeavor to proactively establish robust infrastructure and appropriate funding streams to optimize outcomes when considering the cumulative impacts of COVID-19.