Dysphagia is a known sequela of mechanical ventilation and intubation. About a third of patients discharged from hospital after acute respiratory distress syndrome present with dysphagia. The authors of this review have considered the implications for patients intubated due to COVID-19. They summarise and outline the mechanisms by which dysphagia may develop in this group and suggest ways of managing post-intubation dysphagia. They identify six key mechanisms of dysphagia: 1) oropharyngeal and laryngeal trauma; 2) neuromuscular weakness; 3) reduced laryngeal sensitivity; 4) altered sensorium; 5) gastro-oesophageal reflux and 6) impaired synchronisation of breathing and swallowing. For patients with COVID-19, the authors suggest additional issues of concern related to reduced lung function, reduced physical activity initially, and possibly a larger elderly population with greater comorbidities. Early assessment of dysphagia is encouraged (at 24 hours post-extubation), however caution is advised on the use of potentially aerosol-generating procedures such as endoscopic evaluation of swallowing. Nurse screening of dysphagia (screening tool by Johnson et al, 2018, recommended) is suggested as a way of identifying those patients most in need of further assessment by a speech and language therapist. Where possible, information derived remotely and or from patient history/notes is deemed preferable for patients who are being treated for COVID-19. Where swallowing is found to be unsafe, the authors suggest the use of a nasogastric tube over gastrostomy. This is a timely paper providing a useful overview about potential dysphagia in patients with COVID-19.
Dysphagia following intubation during the COVID-19 pandemic
Reviewed by Roganie Govender
Postintubation Dysphagia During COVID-19 Outbreak-Contemporary Review.
CONTRIBUTOR
Roganie Govender
University College London, Head & Neck Academic Centre, UK.
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