Subject(s)
Autoimmunity/physiology , Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/immunology , IgA Deficiency/etiology , IgA Deficiency/immunology , Pneumonia, Viral/complications , Pneumonia, Viral/immunology , Adult , COVID-19 , Coronavirus Infections/diagnostic imaging , Female , Humans , IgA Deficiency/diagnostic imaging , Pandemics , Plasma Exchange/methods , Pneumonia, Viral/diagnostic imaging , SARS-CoV-2ABSTRACT
IMPORTANCE: Dysphagia is a common complication of critical illness, and many known risk factors are also present in critically ill coronavirus disease 2019 victims. OBJECTIVES: To investigate dysphagia in patients with severe coronavirus disease 2019. DESIGN SETTING AND PARTICIPANTS: In this case series, we report results of dedicated evaluation of swallowing function in six consecutive, tracheotomized coronavirus disease 2019 patients after they had survived acute respiratory distress syndrome and were weaned from the respirator. MAIN OUTCOMES AND MEASURES: Dysphagia was assessed with flexible endoscopic evaluation of swallowing. RESULTS: Three patients suffered from severe dysphagia and airway compromise precluding decannulation, whereas in the other, three swallowing was less critically impaired, and the tracheal cannula could be removed. Four patients presented with additional laryngeal dysfunctions not typically seen in acute respiratory distress syndrome survivors. CONCLUSION AND RELEVANCE: Dysphagia with impaired airway protection is a key feature in coronavirus disease 2019 acute respiratory distress syndrome survivors. Apart from critical illness polyneuropathy, coronavirus disease 2019-related involvement of the peripheral and central nervous system may contribute to swallowing impairment and laryngeal dysfunction.
ABSTRACT
Since the World Health Organization declared the COVID-19 pandemic a Global Public Health Emergency, experts in swallowing are seeking guidance on service delivery and clinical procedures. The European Society for Swallowing Disorders provides considerations to support experts in swallowing disorders in clinical practice. During the COVID-19 pandemic, assessment and treatment of patients with oropharyngeal dysphagia should be provided, while at the same time balancing risk of oropharyngeal complications with that of infection of patients and healthcare professionals involved in their management. Elective, non-urgent assessment may be temporarily postponed and patients are triaged to decide whether dysphagia assessment is necessary; instrumental assessment of swallowing is performed only if processing of the instruments can be guaranteed and clinical assessment has not provided enough diagnostic information for treatment prescription. Assessment and management of oropharyngeal dysphagia is a high-risk situation as it must be considered an aerosol-generating procedure. Personal protective equipment (PPE) should be used. Telepractice is encouraged and compensatory treatments are recommended.