Dysphagia and mechanical ventilation in SARS-COV-2 pneumonia: It's real

Luisa Bordejé Laguna,Pilar Marcos-Neira,Itziar Martínez De Lagrán Zurbano,Esther Mor Marco,Carlos Pollán Guisasola,Constanza Dolores Viñas Soria,Pilar Ricart Martí

doi:10.1016/j.clnu.2021.11.018

Luisa Bordejé Laguna, Pilar Marcos-Neira + Show 5 more

Open Access

https://doi.org/10.1016/j.clnu.2021.11.018

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Abstract

Background & aimsDysphagia can be a consequence of prolonged hospitalization in intensive care units (ICUs) due to severe SARS-CoV-2 pneumonia. This study aims at Identifying the risk factors for dysphagia in ICU patients with COVID-19 pneumonia requiring invasive mechanical ventilation, and at determining the frequency of postextubation dysphagia in this population.MethodsObservational, descriptive, retrospective, cohort study of SARS-CoV-2 pneumonia patients admitted into the ICUs from March to May 2020. The Modified Viscosity Volume Swallowing Test (mV-VST) was used to screening for dysphagia during the first 48 h of extubation in patients requiring mechanical ventilation. Descriptive statistics, univariate and multivariate analyses were conducted. A logistic regression was applied to construct a predictive model of dysphagia.ResultsA total of 232 patients were admitted into the ICUs (age [median 60.5 years (95% CI: 58.5 to 61.9)]; male [74.1% (95% CI: 68.1 to 79.4)]; APACHE II score [median 17.7 (95% CI: 13.3 to 23.2)]; length of mechanical ventilation [median 14 days (95% CI: 11 to 16)]; prone position [79% (95% CI: 72.1 to 84.6)]; respiratory infection [34.5% (95% CI: 28.6 to 40.9)], renal failure [38.5% (95% CI: 30 to 50)])). 72% (167) of patients required intubation; 65.9% (110) survived; and in 84.5% (93) the mV-VST was performed. Postextubation dysphagia was diagnosed in 26.9% (25) of patients. APACHE II, prone position, length of ICU and hospital stay, length of mechanical ventilation, tracheostomy, respiratory infection and kidney failure developed during admission were significantly associated (p < 0.05) with dysphagia. Dysphagia was independently explained by the APACHE II score (OR: 1.1; 95% CI: 1.01 to 1.3; p = 0.04) and tracheostomy (OR: 10.2; 95% CI: 3.2 to 32.1) p < 0.001). The predictive model forecasted dysphagia with a good ROC curve (AUC: 0.8; 95% CI: 0.7 to 0.9).ConclusionsDysphagia affects almost one-third of patients with SARS-COV-2 pneumonia requiring intubation in the ICU. The risk of developing dysphagia increases with prolonged mechanical ventilation, tracheostomy, and poorer prognosis on admission (worst APACHE II score).

Highlights

The WHO declared COVID-19 a pandemic on March 11, 2020 [1]
Mean APACHE II score was 17.7. 78.9% of patients were on hydroxychloroquine while 71.1% received corticosteroids for an average of 7 days
Intubated patients were mechanically ventilated for an average of 14 days; 79% were on prone decubitus and 40.1% required a tracheostomy

Summary

Introduction

The WHO declared COVID-19 a pandemic on March 11, 2020 [1] This new disease brought intensive care units (ICUs) and the health consequences of prolonged hospital admissions into focus. Postextubation dysphagia has a widely variable incidence of 3%e62% depending upon the study consulted [5], and it is most common amongst critical care patients requiring endotracheal intubation for mechanical ventilation [6]. Dysphagia can be a consequence of prolonged hospitalization in intensive care units (ICUs) due to severe SARS-CoV-2 pneumonia. APACHE II, prone position, length of ICU and hospital stay, length of mechanical ventilation, tracheostomy, respiratory infection and kidney failure developed during admission were significantly associated (p < 0.05) with dysphagia. The risk of developing dysphagia increases with prolonged mechanical ventilation, tracheostomy, and poorer prognosis on admission (worst APACHE II score)

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