Swallowing Function in COVID-19 Patients After Invasive Mechanical Ventilation.
Margareta Gonzalez Lindh, Gustav Mattsson, Hirsh Koyi and 3 others
PMID 35036903WHAT IT FOUND
At bedside after ventilation, 20 of 28 patients had swallowing dysfunction, but 9 reached unrestricted oral intake by discharge; at follow-up, 2 patients reported some dysphagia.
Key findings
01Swallowing dysfunction was found in 20 of 28 patients at bedside evaluation after mechanical ventilation.
02By hospital discharge, 9 patients with swallowing dysfunction at bedside had recovered functional oral intake.
03At follow-up, dysphagia had resolved in 13 of 14 patients, 2 patients reported some dysphagia, and 12 patients reported dysphonia and were referred for speech-language pathology evaluation.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
Only 28 patients were included, so the findings are limited. Only patients referred to speech-language pathology after ventilation were included, so patients who were not referred were not assessed. Swallowing was judged by oral intake level rather than instrumental tests, so the study does not show the underlying swallowing mechanics. Follow-up swallowing symptoms were patient-reported, not clinician-rated, and wording was inconsistent. Prone position duration could not be determined, so its possible effect on swallowing cannot be judged. The cohort was from 3 ICUs in one region and was a substudy of a larger cohort. Follow-up was not obtained for 6 patients, including 1 death.
The easy way to misread this
Do not conclude that swallowing problems after ventilation are minor because many patients improved by follow-up. At bedside, 20 of 28 patients had swallowing dysfunction and 15 were completely or partly tube dependent; the study also did not use instrumental swallowing tests, so it does not show that oral intake alone confirms safe swallowing.