Background
The SARS-CoV-2 virus (termed COVID-19) is a novel respiratory virus,
which has led to an international pandemic. COVID-19 has resulted in an
unprecedented number of critically ill adults, which has overwhelmed
intensive care unit (ICU) services worldwide. Endotracheal intubation
and mechanical ventilation have been a central management procedure for
critically ill patients with COVID-19 in ICU settings.
Post-extubation dysphagia (PED) and dysphonia are common post-extubation
in critical care patients (1-4). Iatrogenic causes include prolonged
intubation (5) and intubation injury including laryngeal oedema,
granulations, ulceration and vocal cord immobility (6). Other potential
factors are delirium (7), proning (8), disuse atrophy and critical
illness neuropathy or myopathy during ICU stay (9) and neurological
manifestations of COVID-19 (10). Also, tracheostomy insertion can lead
to aspiration risk and difficulties managing secretions (3). PED is
associated with worse outcomes in ICU including aspiration pneumonia,
prolonged tube feeding, delayed initiation of oral intake, prolonged
hospitalisation, and increased morbidity and mortality (11, 12).
Dysphonia is another recognised complication of intubation reported
amongst adults with COVID-19 (3). Post-extubation dysphonia results from
vocal cord immobility, laryngopharyngeal reflux, granuloma, reduced
breath support for phonation and vocal cord fatigue. Endotracheal tube
(ETT) size (13) and cuff pressure during intubation (14) have been
identified as risk factors for post-extubation dysphonia. Age and
duration of intubation has also been linked with prolonged dysphonia
post-extubation in previous critical care research (15).
The impact of intubation as part of COVID-19 management on swallowing
and voice is unclear internationally, as are the dysphagia and dysphonia
rehabilitation needs within this population (16). This study aims to
characterise the presence and degree of post-extubation voice and
swallowing difficulties amongst adults requiring intubation as part of
medical management of COVID-19 in the Republic of Ireland (ROI) during
the first wave of the pandemic. Specific research objectives are to (i)
explore the presence, degree and trajectory of dysphonia and dysphagia
post-extubation in adults with COVID-19 across the ROI between March and
June 2020 inclusive; (ii) identify variables, which predict
post-extubation oral intake status and voice quality, and (iii)
determine SLT evaluation and rehabilitation indicated and provided to
this cohort.