Dysphagic disorder in a cohort of COVID-19 patients: Evaluation and evolution

Samuele Ceruti; Andrea Glotta; Anna Galli; Maira Biggiogero; Giovanni Bona; Romano Mauri; Andrea Saporito; Xavier Capdevila

doi:10.1016/j.amsu.2021.102837

Dysphagic disorder in a cohort of COVID-19 patients: Evaluation and evolution

Ann Med Surg (Lond). 2021 Sep:69:102837. doi: 10.1016/j.amsu.2021.102837. Epub 2021 Sep 8.

Authors

Samuele Ceruti¹, Andrea Glotta¹, Anna Galli², Maira Biggiogero³, Giovanni Bona³, Romano Mauri¹, Andrea Saporito^{4

5}, Xavier Capdevila⁶

Affiliations

¹ Clinica Luganese Moncucco, Critical Care Department, Via Moncucco, 10 - 6900, Lugano, Switzerland.
² Clinica Luganese Moncucco, Physiotherapy Service, Via Moncucco, 10 - 6900, Lugano, Switzerland.
³ Clinica Luganese Moncucco, Clinical Research Unit, Via Moncucco, 10 - 6900, Lugano, Switzerland.
⁴ Bellinzona Regional Hospital, Service of Anesthesia, Bellinzona, Switzerland.
⁵ Faculty of Biomedical Sciences, University of Lugano (USI), Lugano, Via Ospedale 12, 6500, Bellinzona, Switzerland.
⁶ Centre Hospitalier Universitaire de Montpellier, Department of Anesthesia and Intensive Care, 191 Av. du Doyen Gaston Giraud, 34295, Montpellier, France.

Abstract

Background: COVID-19 is a multisystem disease complicated by respiratory failure requiring sustanined mechanical ventilation (MV). Prolongued oro-tracheal intubation is associated to an increased risk of dysphagia and bronchial aspiration. Purpose of this study was to investigate swallowing disorders in critically ill COVID-19 patients.

Material and methods: This was a retrospective study analysing a consecutive cohort of COVID-19 patients admitted to the Intensive Care Unit (ICU) of our hospital. Data concerning dysphagia were collected according to the Gugging Swallowing Screen (GUSS) and related to demographic characteristics, clinical data, ICU Length-Of-Stay (LOS) and MV parameters.

Results: From March 2 to April 30, 2020, 31 consecutive critically ill COVID-19 patients admitted to ICU were evaluated by speech and language therapists (SLT). Twenty-five of them were on MV (61% through endotracheal tube and 19% through tracheostomy); median MV length was 11 days. Seventeen (54.8%) patients presented dysphagia; a correlation was found between first GUSS severity stratification and MV days (p < 0.001), ICU LOS (p < 0.001), age (p = 0.03) and tracheostomy (p = 0.042). No other correlations were found. At 16 days, 90% of patients had fully recovered; a significant improvement was registered especially during the first week (p < 0.001).

Conclusion: Compared to non-COVID-19 patiens, a higher rate of dysphagia was reported in COVID-19 patients, with a more rapid and complete recovery. A systematic early SLT evaluation of COVID-19 patients on MV may thus be useful to prevent dysphagia-related complications.

Keywords: Deglutition disorders; Dysphagia; Intensive care units; Mechanical ventilation; Tracheostomy.