Abstract
Objectives: This study aims to (i) investigate post-extubation
dysphagia and dysphonia amongst adults intubated with SARS-COV-2
(COVID-19) and referred to speech and language therapy (SLT) in acute
hospitals across the Republic of Ireland (ROI) between March and June
2020; (ii) identify variables predictive of post-extubation oral intake
status and dysphonia and (iii) establish SLT rehabilitation needs and
services provided to this cohort.
Design: A multi-site prospective observational cohort study
Participants: 100 adults with confirmed COVID-19 who were
intubated across eleven acute hospital sites in ROI and who were
referred to SLT services between March and June 2020 inclusive.
Main Outcome Measures: Oral intake status, level of diet
modification and perceptual voice quality.
Results: Based on initial SLT assessment, 90% required altered
oral intake and 59% required tube feeding with 36% unable for oral
intake. Age (OR 1.064; 95% CI 1.018-1.112), proning (OR 3.671; 95% CI
1.128-11.943), and pre-existing respiratory disease (OR 5.863; 95% CI
1.521-11.599) were predictors of oral intake status post-extubation.
Two-thirds (66%) presented with dysphonia post-extubation. Intubation
injury (OR 10.471; 95% CI 1.060-103.466) and pre-existing respiratory
disease (OR 24.196; 95% CI 1.609-363.78) were predictors of
post-extubation voice quality. Thirty-seven percent required dysphagia
rehabilitation post-extubation whereas 20% needed voice rehabilitation.
Dysphagia and dysphonia persisted in 27% and 37% cases respectively at
hospital discharge.
Discussion: Post-extubation dysphagia and dysphonia were
prevalent amongst adults with COVID-19 across the ROI. Predictors
included iatrogenic factors and underlying respiratory disease. Prompt
evaluation and intervention is needed to minimise complications and
inform rehabilitation planning.