263 Airway, Voice and Swallow Outcomes Following Endotracheal Intubation and Mechanical Ventilation For COVID-19 Pneumonitis: Preliminary Results of a Prospective Cohort Study

K Miu,B Miller,V Burnay,C Tornari,I Ahmed,P Murphy,Y Karagama,A Slack

doi:10.1093/bjs/znab134.049

K Miu, B Miller + Show 6 more

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https://doi.org/10.1093/bjs/znab134.049

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Abstract

IntroductionThe COVID-19 pandemic has placed exceptional demands on Intensive Care Units (ICU) across the world – particularly requiring patients to be intubated and mechanically ventilated. Laryngeal injury following intubation is a common occurrence, therefore this study aims to analyse airway, voice, and swallow (AVS) outcomes of patients intubated for COVID-19 pneumonitis and compares it to intubated non-COVID-19 respiratory patients and other ICU admissions.MethodWe collected data from inpatient records, and follow-up clinics on intubated adult patients discharged from a tertiary care hospital ICU between 01/03/20 and 30/04/20. Patients were assessed with the AVS Scale, Voice Handicap Index-10 (VHI-10), and Eating Assessment Tool-10 (EAT-10).Results86 patients were admitted with COVID-19 pneumonitis, 17 patients were admitted with non-COVID-19 respiratory failure, and 26 patients were admitted with a non-respiratory diagnosis.The COVID-19 cohort demonstrated higher rates of AVS difficulties (airway 59% vs 44% and 31%, voice 40% vs 19% and 19%, swallow 21% vs 6% and 12%). VHI-10 and EAT-10 scores showed no significant differences between groups.ConclusionsPatients intubated for COVID-19 pneumonitis reported higher rates of AVS difficulties against non-COVID-19 reasons for intubation. Robust prospective screening protocols are essential to improving patient outcomes by highlighting and therefore managing laryngological sequelae that occur following intubation.

Highlights

The coronavirus pandemic has resulted in unprecedented rates of patients requiring intubation and ventilation over a short period of time
In this paper we present 3-month data on airway, voice, and swallow outcomes of patients intubated and mechanically ventilated for COVID-19 pneumonitis, as compared against non-COVID-19 respiratory and other emergency intensive care admissions
Over a 2-month period (March 1st 2020—April 30th 2020) 141 patients were discharged from our institution following emergency Intensive Care Units (ICU) admission for intubation and mechanical ventilation. 86 patients were admitted with the primary diagnosis of COVID–19 pneumonitis, 17 patients were admitted with nonCOVID–19 respiratory failure, and 26 patients were admitted with a non-respiratory primary diagnosis. 12 patients did not meet the inclusion criteria and were excluded from data analysis (5 acute upper aerodigestive tract pathology, 3 acute neurogenic causes for AVS failure, 1 patient on pre-existing long term ventilation, 3 deceased prior to first follow up)

Summary

Introduction

The coronavirus pandemic has resulted in unprecedented rates of patients requiring intubation and ventilation over a short period of time. The first wave of the coronavirus (COVID-19) pandemic has placed exceptional demands on Intensive Care Units (ICU) across the world. A majority of such injuries are trivial and self-limiting, moderate to severe injuries occur in an estimated 13-31% of patients [3]. Such injuries include laryngotracheal stenosis, vocal cord immobility, ulceration and granulation, and can carry significant morbidity without prompt diagnosis and treatment. Whilst the incidence of post-intubation laryngeal injury in the COVID population remains unknown, early reports have postulated the apparent potential for COVID-19 to predispose to laryngeal oedema, ulceration, and florid laryngotracheitis [4,5]

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