Postorotracheal intubation dysphagia in patients with COVID-19: A retrospective study

ABSTRACT

BACKGROUND:

The cause of oropharyngeal dysphagia in patients with coronavirus disease (COVID-19) can be multifactorial and may underly limitations in swallowing rehabilitation.

OBJECTIVE:

Analyze the factors related to dysphagia in patients with COVID-19 immediately after orotracheal extubation and the factors that influence swallowing rehabilitation.

DESIGN AND SETTING:

A retrospective study.

METHODS:

The presence of dysphagia was evaluated using the American Speech-Language Hearing Association National Outcome Measurement System (ASHA NOMS) scale and variables that influenced swallowing rehabilitation in 140 adult patients who required invasive mechanical ventilation for >48 h.

RESULTS:

In total, 46.43% of the patients scored 1 or 2 on the ASHA NOMS (severe dysphagia) and 39.29% scored 4 (single consistency delivered orally) or 5 (exclusive oral diet with adaptations). Both the length of mechanical ventilation and the presence of neurological disorders were associated with lower ASHA NOMS scores (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.74–0.87 P < 0.05; and OR: 0.13, 95% CI: 0.61–0.29; P < 0.05, respectively). Age and the presence of tracheostomy were negatively associated with speech rehabilitation (OR: 0.92; 95% CI: 0.87–−0.96; OR: 0.24; 95% CI: 0.80–−0.75), and acute post-COVID-19 kidney injury requiring dialysis and lower scores on the ASHA NOMS were associated with longer time for speech therapy outcomes (β: 1.62, 95% CI, 0.70–3.17, P < 0.001; β: −1.24, 95% CI: −1.55–−0.92; P < 0.001).

CONCLUSION:

Prolonged orotracheal intubation and post-COVID-19 neurological alterations increase the probability of dysphagia immediately after extubation. Increased age and tracheostomy limited rehabilitation.

KEYWORDS (MeSH terms):
Deglutition; Intubation; COVID-19; Deglutition disorders; Rehabilitation

AUTHOR’S KEYWORDS:
Post orotracheal intubation; Dysphagia; Swallowing; Tracheostomy