Dysphagia presentation and management following COVID-19: an acute care tertiary centre experience.

C Dawson,R Capewell,J Wheeler,N Sharma,P Pracy,M Wood,K Reid,P Nankivell,S Adamson,S Ellis,S Matthews,M Shaw,L Fitch

doi:10.1017/s0022215120002443

C Dawson, R Capewell + Show 11 more

Open Access

https://doi.org/10.1017/s0022215120002443

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Abstract

As the pathophysiology of COVID-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital. During the first wave of the COVID-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status. Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with COVID-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.

Highlights

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected over 24 million people globally, with over 327 643 cases reported in the UK.[1]
As patients are optimised on the Intensive Treatment Unit (ITU)/ward setting and survive Covid-19, the impact of intubation and extubation, proning, tracheostomy, critical illness and delirium become apparent
These patients have a significant burden of dysphagia requiring substantial intervention, in a setting made more complex by the novel symptomatology of an emerging disease, and the requirement to deliver this care in personal protective equipment (PPE)

Summary

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected over 24 million people globally, with over 327 643 cases reported in the UK.[1]. The role of swallow rehabilitation in patients with Covid-19 has not been reported, despite many of these patients presenting with dysphagia in acute care hospitals. As patients are optimised on the Intensive Treatment Unit (ITU)/ward setting and survive Covid-19, the impact of intubation and extubation, proning, tracheostomy, critical illness and delirium become apparent. These patients have a significant burden of dysphagia requiring substantial intervention, in a setting made more complex by the novel symptomatology of an emerging disease, and the requirement to deliver this care in personal protective equipment (PPE)

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