Clinical profile and recovery pattern of dysphagia in the COVID-19 patient: A prospective observational cohort within NSW.
Nicola A Clayton, Elizabeth Walker, Amy Freeman-Sanderson
PMID 35177342WHAT IT FOUND
Most ICU patients with COVID-19 referred to speech pathology had swallowing impairment, often profound, but 81% resolved before discharge.
Longer intubation, ventilation and stay tracked with slower oral intake and feeding recovery.
Key findings
01Dysphagia was present on initial assessment in 93% of patients, and 44% had profound swallowing impairment (FOIS 1).
02Dysphagia resolved by discharge in 81% of patients, with median time to resolution 44 days from ICU admission.
03Longer duration of intubation, mechanical ventilation, ICU stay and hospital stay were associated with later speech pathology assessment, later oral feeding, longer recovery and longer enteral feeding.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Only 27 patients were included, so the findings are descriptive and should not be generalised broadly. Patients were included only if referred to speech pathology, so all ICU patients with COVID-19 were not assessed and the prevalence and severity may not represent the wider ICU population. There was no comparison group and no intervention effect was tested, so recovery cannot be attributed to speech pathology care, rehabilitation, tube removal or other ICU treatments. Routine instrumental swallowing assessment, especially flexible endoscopic evaluation of swallowing, was largely not performed because of aerosol precautions, and only 5 patients had videofluoroscopy. The study did not describe dysphagia rehabilitation strategies in detail, so clinicians cannot tell what active therapy was given. Site-specific referral practices, infection control protocols and delays may have affected when patients were assessed and treated. Proning was not captured, and respiratory disease history was not reported at a high frequency, so possible contributors to swallowing difficulty may be missing.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read the 81% resolution rate as proof that speech pathology treatment caused recovery. This was a small observational cohort of referred patients, with no comparison group, and patients received mechanical ventilation, endotracheal tubes, tracheostomy, enteral feeding and speech pathology care, so the contribution of any single component cannot be separated.