Curr Health Sci J, vol. 47, no. 2, 2021

Dysphagia Severity and Management in Patients with COVID-19

[Review]

Athanasia Printza(1), Miroslav Tedla(2,3), Zofia Frajkova(2,4), Konstantinos Sapalidis(5), Stefanos Triaridis(1)


(1)1st Otorhinolaryngology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece,
(3)Institute of Cancer and Genomic Sciences, University of Birmingham, UK,
(4)Department of Communication Disorders, Faculty of Education, Comenius University, Bratislava, Slovakia,
(5)3rdSurgery Department, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Greece


Abstract:

COVID-19 has resulted in unprecedented numbers of patients treated at intensive care units (ICUs). Dysphagia is a key concern in critical illness survivors. We investigated the severity of dysphagia in COVID-19 and the need to adapt practices to provide efficient care. We reviewed the literature on COVID-19, post-critical-illness dysphagia, and dysphagia and tracheostomy guidelines during the pandemic. Critically ill COVID-19 patients present a high incidence of dysphagia, aggravated by respiratory distress, deconditioning, and neurological complications. Mechanical ventilation (MV), delirium, sedation and weakness are worse in COVID-19 than in other etiologies of critical care. In awake patients, respiratory compromise impairs breathing-swallowing-coughing coordination. Tracheostomy reduces laryngopharyngeal trauma, sedation, delirium, ICU stay and improves swallowing rehabilitation. Tracheostomy weaning and swallowing evaluation is complex in COVID-19 due to respiratory instability and a team discussion will guide adaptations. Patients assessed in the ICU were 67% recommended to be nil by mouth (were aspirating). Two months following hospital discharge, 83% of those who had undergone tracheostomy were managing a normal diet. Severely ill COVID-19 patients are expected to regain swallow function. Dysphagia care is based on adaptation of practices to the patients’ multiple impairments.


Keywords:
Dysphagia, COVID-19, Swallowing, Critically ill, Tracheostomy



Corresponding:
Athanasia Printza: 1st Otorhinolaryngology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece, e-mail: aprintza@auth.gr


DOI 10.12865/CHSJ.47.02.01 - Download PDF