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

Abstract

Objectives: 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.

Results: 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.

Conclusion: 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.

Keywords: COVID-19; Coronavirus; Dysphagia; Rehabilitation; Swallowing.

Fig. 1.

There was a positive correlation between the number of days a patient was intubated and the number of days from intubation to commencing oral intake for both (a) the endotracheal tube group (R² = 0.84, p < 0.01) and (b) the tracheostomy group (R² = 0.31, p < 0.01). The mean (standard deviation) time from extubation to oral intake (5.2 (2.3) days) or tracheostomy insertion to oral intake (14.7 (6.5) days) was not associated with duration of intubation for either (c) the endotracheal tube group (R² = 0.01, p = 0.63) or (d) the tracheostomy group (R² = 0.01, p = 0.44). (e) For the tracheostomy group, there was no correlation between the number of days on sedation and the period of time from stopping sedation to starting oral intake (R² = 0.00, p = 0.58).

Fig. 2.

The degree of altered diet recommendations for patients at each stage – based on initial assessments on the initial intensive treatment unit (ITU) and on the ward, and assessment at discharge from speech and language therapy (SLT) – for the endotracheal tube (ETT) cohort (a–c respectively), the tracheostomy cohort (d–f respectively) and the ward cohort (g & h respectively). NBM = nil by mouth; L = level of diet (see Table 1)