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.