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Jones, Robyn Caitlin

University of British Columbia

Purpose: Patients with severe COVID-19 often receive prolonged endotracheal intubation which increases dysphagia risk. Consequences can be severe, including multimorbidity and mortality. We aimed to describe swallowing physiology and explore associated factors in patients with COVID-19 after prolonged intubation (> 48 hr). Method: Retrospectively, we examined videofluoroscopic swallow study (VFSS) data from patients at a single hospital from February 1 – December 27, 2020. Imaging was conducted following hospital protocols. Boluses were mixed with Liquid Polibar (IDDSI Level 0; 25% w/v) or EZ-HD powdered barium (IDDSI 2–4, 6-0; 28–56% w/w). Two independent raters scored boluses captured at 15–30 fps with the Penetration-Aspiration Scale (PAS) and Modified Barium Swallow Impairment Profile (MBSImP™). We resolved disagreements by consensus. Results were summarized descriptively with frequency counts, percentages, and medians. We explored associations between airway protection, clinical variables, and physiologic components with Fisher’s exact and Wilcoxon rank sum tests. Results: Seventeen patients (13 males; 42–82 years) met inclusion and analysis criteria. Median (IQR) days of intubation and hospitalization were 11.8 (10.6) and 40.0 (34.0), respectively. Fifty-one boluses were analyzed: IDDSI Level 0 (28, 55%), 2 (9, 18%), 3 (2, 4%), 4 (5, 10%), 6-0 (7, 14%). Eight (47%) patients had impaired airway protection (PAS >2) with liquids. Across boluses, frequently impaired oral phase components (n, %) included: pharyngeal swallow initiation (38, 76%), oral residue (32, 65%), and tongue control (17, 63%). Pharyngeal phase impairments included: anterior hyoid excursion (42, 82%), laryngeal elevation (30, 59%) and pharyngeal residue (30, 59%). Airway protection on liquid swallows was significantly associated with diabetes (p = 0.029), laryngeal vestibule closure (p = 0.002), and tongue base retraction (p = 0.029). Conclusion: Our study is the first to describe swallowing physiology in this population at a Canadian site, and we reported novel data with the psychometrically validated MBSImP™. Our sample had high rates of impaired oral, laryngeal, and pharyngeal function, suggesting weakness of tongue, laryngeal, and pharyngeal muscles, and reduced sensation and coordination. These findings highlight need for instrumental assessment, and we suggest future studies include case control design focused on upper aerodigestive tract biomechanical measures.

Text

2024-08-15

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/88952

Audiology and Speech Sciences

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/