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Postintubation Dysphagia During COVID-19 Outbreak-Contemporary Review -…
Postintubation Dysphagia During COVID-19 Outbreak-Contemporary Review
Causes of Postintubation Dysphagia
Endotracheal Intubation
Multifactorial changes - mainly mechanical and cognitive
Increased risk
Postintubation voice disorder
Dysphagia
Increased risk of aspiration pneumonia
Laryngeal and tracheal injury
Predictive Factors Increasing Risk of Dysphagia and Aspiration After Extubation
Changes in voice quality
Degree of voice disorder
Age
Whether the patient has already had dysphagia prior to intubation
Congestive heart failure
Functional status
Increased hospital length of stay
Hypocholesterolemia
Increased ICU length of stay
Multiple intubations
Increased operative time
Perioperative transesophageal echocardiography
Sepsis
Duration of intubation
Incidence
General Incidence Rates (Not Associated With COVID-19)
Intubation lasting more than 4 days
3% to 62% of patients recovering after critical illness
Patients intubated for more than 48 h (prevalence of dysphagia increases by 56% and 25% of these individuals aspirate silently)
Mechanisms of Development of Postintubation Dysphagia
Reduced Sensitivity
Interference with the protective reflexes of swallowing
Rapid changes in chemoreceptors and mechanoreceptors of upper respiratory tract
Altered Sensorium
Development of delirium
31% more likely to aspirate liquids
Neuromuscular Weakness
Atrophy of structures involved in swallowing
Dyscoordination of muscles and nerves
Gastroesophageal Reflux (GERD)
Adversely affects laryngeal sphincter function
Oropharyngeal and Laryngeal Trauma
Impaired elevation of the hyolaryngeal complex and laryngeal sphincter
Mucosal abraison
Inflammations
Hematomas
Ulcerations in the area of vocal cords, arytenoids, epiglottis, and the base of the tongue
Dislocation and subluxation of arytenoid cartilage
Injury of recurrent laryngeal nerve
Vocal cord paresis
Impaired Respiratory-Swallowing Coordination
Impairment of synchronization
Specifics of Postintubation Dysphagia Management in COVID-19 Patients
Characteristics
Reduced lung function in terms of short and weakened breath
Lung fibrosis
Considerations
Social deprivation
Age
History of comorbidities
Reduced lung function
Recommendations
Modify particular aerosol-generating procedures limiting the usage of instrumental swallowing examinations
Consider postponing swallowing examinations unless necessary
Evaluation of Swallowing in Patients with COVID-19 After Orotracheal Intubation Tube Removal
Early detection of postintubation dysphagia to reduce the incidence of complications
Rapid sensitive screening
Timing of swallow assessment after patient extubation varies and there is no consensus on screening
Some studies suggest screening takes place 1 to 5 days after extubation
Screening 24 h after extubation
Penetration and aspiration significantly reduced
Respiratory protection improved in 79% of patients
Faster return to a less restricted diet
Other studies suggest swallowing assessment does not need to be delayed
82% of patients completing swallowing screening in the first hour after extubation
Screening tools
Standard protocols for screening and diagnosis of postintubation dysphagia are unclear
Risk of dysphagia mainly associated with drooling, multiple swallowing, coughing, and voice change during swallowing
Screening should indicate the need for further clinical or instrumental examination of swallowing
Swallowing screening has been developed for patients intubated for more than 48 h
Clinical swallow examination