Moving Forward with Dysphagia Care: Implementing Strategies during the COVID-19 Pandemic and Beyond

Mark A Fritz¹, Rebecca J Howell², Martin B Brodsky^{3

4

5}, Debra M Suiter⁶, Shumon I Dhar⁷, Anais Rameau⁸, Theresa Richard⁹, Michelle Skelley¹⁰, John R Ashford¹⁰, Ashli K O'Rourke¹¹, Maggie A Kuhn¹²

Affiliations

¹ Department of Otolaryngology, Head and Neck Surgery, University of Kentucky, 740 S Limestone, E300E, Lexington, KY, 40536, USA. Mark.fritz@uky.edu.
² Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati, Cincinnati, USA.
³ Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, USA.
⁴ Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, USA.
⁵ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁶ Department of Communication Sciences and Disorders, University of Kentucky, Lexington, USA.
⁷ Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, USA.
⁸ Department of Otolaryngology, Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA.
⁹ Mobile Dysphagia Diagnostics, Buffalo, NY, USA.
¹⁰ SA Swallowing Services, Nashville, TN, USA.
¹¹ Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, USA.
¹² Department of Otolaryngology, Head and Neck Surgery, University of California-Davis Medical Center, Sacramento, USA.

PMID: 32519150
PMCID: PMC7282541
DOI: 10.1007/s00455-020-10144-9

Review

Moving Forward with Dysphagia Care: Implementing Strategies during the COVID-19 Pandemic and Beyond

Mark A Fritz et al. Dysphagia. 2021 Apr.

. 2021 Apr;36(2):161-169.

doi: 10.1007/s00455-020-10144-9. Epub 2020 Jun 9.

Authors

Affiliations

¹ Department of Otolaryngology, Head and Neck Surgery, University of Kentucky, 740 S Limestone, E300E, Lexington, KY, 40536, USA. Mark.fritz@uky.edu.
² Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati, Cincinnati, USA.
³ Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, USA.
⁴ Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, USA.
⁵ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁶ Department of Communication Sciences and Disorders, University of Kentucky, Lexington, USA.
⁷ Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, USA.
⁸ Department of Otolaryngology, Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA.
⁹ Mobile Dysphagia Diagnostics, Buffalo, NY, USA.
¹⁰ SA Swallowing Services, Nashville, TN, USA.
¹¹ Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, USA.
¹² Department of Otolaryngology, Head and Neck Surgery, University of California-Davis Medical Center, Sacramento, USA.

PMID: 32519150
PMCID: PMC7282541
DOI: 10.1007/s00455-020-10144-9

Abstract

Growing numbers of SARS-CoV-2 cases coupled with limited understanding of transmissibility and virulence, have challenged the current workflow and clinical care pathways for the dysphagia provider. At the same time, the need for non-COVID-19-related dysphagia care persists. Increased awareness of asymptomatic virus carriers and variable expression of the disease have also focused attention to appropriate patient care in the context of protection for the healthcare workforce. The objective of this review was to create a clinical algorithm and reference for dysphagia clinicians across clinical settings to minimize spread of COVID-19 cases while providing optimal care to patients suffering from swallowing disorders. Every practitioner and healthcare system will likely have different constraints or preferences leading to the utilization of one technique over another. Knowledge about this pandemic increases every day, but the algorithms provided here will help in considering the best options for proceeding with safe and effective dysphagia care in this new era.

Keywords: Assessment; COVID-19; Dysphagia; SARS-CoV-2; Telemedicine; Treatment.

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Figures

**Fig. 1**
Dysphagia Intervention Considerations

**Fig. 2**
Schematic of Dysphagia Evaluation and Treatment. Swallowing therapy strongly recommended. *FEES* flexible endoscopic evaluation of swallowing, *PUI* patient under investigation, *SLP* speech-language pathologist *VFSS*, videofluoroscopic swallow study

**Fig. 3**
Telemedicine for Dysphagia Evaluation

See this image and copyright information in PMC

References

1. Johns Hopkins University and Medicine. Coronavirus Resource Center. 2020; https://coronavirus.jhu.edu/map.html. Accessed June 5, 2020.
1. Grasselli G, Pesenti A, Cecconi M. Critical Care Utilization for the COVID-19 outbreak in Lombardy, Itlay: early experience and forecast during an emergency response. JAMA. 2020 doi: 10.1001/jama.2020.4031. - DOI - PubMed
1. Lovato A, de Filippis C. Clinical Presentation of COVID-19: A Systematic Review Focusing on Upper Airway Symptoms. Ear, Nose, Throat Journal. 2020 doi: 10.1177/0145561320920762. - DOI - PubMed
1. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, Barnaby DP, Becker LB, Chelico JD, Cohen SL, Cookingham J, Coppa K, Diefenbach MA, Dominello AJ, Duer-Hefele J, Falzon L, Gitlin J, Hajizadeh N, Harvin TG, Hirschwerk DA, Kim EJ, Kozel ZM, Marrast LM, Mogavero JN, Osorio GA, Qiu M, Zanos TP. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020 doi: 10.1001/jama.2020.6775. - DOI - PMC - PubMed
1. Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, Merdji H, Clere-Jehl R, Schenck M, Fagot Gandet F, Fafi-Kremer S, Castelain V, Schneider F, Grunebaum L, Angles-Cano E, Sattler L, Mertes PM, Meziani F. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020 doi: 10.1007/s00134-020-06062-x. - DOI - PMC - PubMed

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Moving Forward with Dysphagia Care: Implementing Strategies during the COVID-19 Pandemic and Beyond

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Moving Forward with Dysphagia Care: Implementing Strategies during the COVID-19 Pandemic and Beyond

Authors

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Medical

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