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Sant'anna SFN, Duprat ADC, de Andrada E Silva MA, de Queiroz Prado Bittencourt MF. Dysphonia and Throat Clearing in Singers During the COVID-19 Pandemic in Brazil. J Voice 2023:S0892-1997(23)00159-5. [PMID: 37722981 PMCID: PMC10192596 DOI: 10.1016/j.jvoice.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE The COVID-19 pandemic in Brazil affected the lives of singers, with negative impacts of the disease on the voice, such as dysphonia and throat clearing. This study aims to evaluate the presence of dysphonia and throat clearing in singers during the COVID-19 pandemic in Brazil. MATERIAL AND METHODS This is a cross-sectional analytical study with a sample of 154 singers from all over Brazil. Data collection was carried out online, by completing the questionnaire created by the researcher using Google Forms. The following were considered the outcome variables: voice impairment and throat clearing. The bivariate analysis was performed to test the relationship between COVID-19 infection and voice impairment, COVID-19 infection and throat clearing, COVID-19 infection and laryngeal complaints (voice impairment and throat clearing). RESULTS In this study, the mean age of the singers was 35.8 (Standard deviation = ±10.2 years) and 59.2% were female. Most of them worked as professional singers (81.1%) and had more than 10 years of professional experience (57.4%), mainly singing pop music (85.4%). A total of 62% reported vocal alterations during the COVID-19 infection and 53% had vocal alterations after the infection, with 44.0% reporting the onset of throat clearing after the infection. There was a significant association between COVID-19 infection and having voice impairment (P = 0.03; prevalence ratio - PR: 2.33; CI: 1.04-5.46). An association was observed between the onset of throat clearing and the occurrence of COVID-19 infection (P = 0.001; PR: 9.13; CI: 2.47-64.42). CONCLUSIONS The results indicated that there is an association between COVID-19 infection and complaints of dysphonia and throat clearing in Brazilian singers. This study demonstrates the importance of guidance to singers infected with COVID-19 by health voice processionals.
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Dawson C, Nankivell P, Pracy JP, Capewell R, Wood M, Weblin J, Parekh D, Patel J, Skoretz SA, Sharma N. Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study. Dysphagia 2023; 38:657-666. [PMID: 35841455 PMCID: PMC9287536 DOI: 10.1007/s00455-022-10496-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/01/2022] [Indexed: 11/03/2022]
Abstract
To explore laryngeal function of tracheostomised patients with COVID-19 in the acute phase, to identify ways teams may facilitate and expedite tracheostomy weaning and rehabilitation of upper airway function. Consecutive tracheostomised patients underwent laryngeal examination during mechanical ventilation weaning. Primary outcomes included prevalence of upper aerodigestive oedema and airway protection during swallow, tracheostomy duration, ICU frailty scores, and oral intake type. Analyses included bivariate associations and exploratory multivariable regressions. 48 consecutive patients who underwent tracheostomy insertion as part of their respiratory wean following invasive ventilation in a single UK tertiary hospital were included. 21 (43.8%) had impaired airway protection on swallow (PAS ≥ 3) with 32 (66.7%) having marked airway oedema in at least one laryngeal area. Impaired airway protection was associated with longer total artificial airway duration (p = 0.008), longer tracheostomy tube duration (p = 0.007), multiple intubations (p = 0.006) and was associated with persistent ICU acquired weakness at ICU discharge (p = 0.03). Impaired airway protection was also an independent predictor for longer tracheostomy tube duration (p = 0.02, Beta 0.38, 95% CI 2.36 to 27.16). The majority of our study patients presented with complex laryngeal findings which were associated with impaired airway protection. We suggest a proactive standardized scoring and review protocol to manage this complex group of patients in order to maximize health outcomes and ICU resources. Early laryngeal assessment may facilitate weaning from invasive mechanical ventilation and liberation from tracheostomy, as well as practical and objective risk stratification for patients regarding decannulation and feeding.
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Affiliation(s)
- C Dawson
- Department of Therapy Services, Queen Elizabeth Hospital Birmingham NHSFT, Birmingham, UK.
- University of Birmingham Institute of Clinical Sciences, Birmingham, UK.
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada.
| | - P Nankivell
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UK
| | - J P Pracy
- Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UK
| | - R Capewell
- Department of Therapy Services, Queen Elizabeth Hospital Birmingham NHSFT, Birmingham, UK
| | - M Wood
- Department of Therapy Services, Queen Elizabeth Hospital Birmingham NHSFT, Birmingham, UK
| | - J Weblin
- Department of Therapy Services, Queen Elizabeth Hospital Birmingham NHSFT, Birmingham, UK
| | - D Parekh
- Centre for Translational Inflammation and Fibrosis Research, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - J Patel
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - S A Skoretz
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Providence Health Care, Vancouver, Canada
| | - N Sharma
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UK
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3
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Bouldin E, Sandeep S, Gillespie A, Tkaczuk A. Otolaryngologic Symptom Severity Post SARS-CoV-2 Infection. J Voice 2023:S0892-1997(23)00080-2. [PMID: 37068983 PMCID: PMC9977624 DOI: 10.1016/j.jvoice.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023]
Abstract
Objective(s) To assess laryngologic symptomatology following SARS-CoV-2 infection and determine whether symptom severity correlates with disease severity. Methods Single-institution survey study in participants with documented SARS-CoV-2 infection between March 2020 and February 2021. Data acquired included demographic, infection severity characteristics, comorbidities, and current upper aerodigestive symptoms via validated patient reported outcome measures. Primary outcomes of interest were scores of symptom severity questionnaires. COVID-19 severity was defined by hospitalization status. Descriptive subgroup analyses were performed to investigate differences in demographics, comorbidities, and symptom severity in hospitalized participants stratified by ICU status. Multivariate logistical regression was used to evaluate significant differences in symptom severity scores by hospitalization status. Results Surveys were distributed to 5300 individuals with upper respiratory infections. Ultimately, 470 participants with COVID-19 were included where 352 were hospitalized and 118 were not hospitalized. Those not hospitalized were younger (45.87 vs. 56.28 years), more likely female (74.17 vs. 58.92%), and less likely white (44.17 vs. 52.41%). Severity of dysphonia, dyspnea, cough, and dysphagia was significantly worse in hospitalized patients overall and remained worse at all time points. Cough severity paradoxically worsened in hospitalized respondents over time. Dyspnea scores remained abnormally elevated in respondents even 12 months after resolution of infection. Conclusion Results indicate that laryngologic symptoms are expected to be worse in patients hospitalized with COVID-19. Dyspnea and cough symptoms can be expected to persist or even worsen by one-year post infection in those who were hospitalized. Dysphagia and dysphonia symptoms were mild. Non-hospitalized participants tended to have minimal residual symptoms by one year after infection.
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Affiliation(s)
- Emerson Bouldin
- Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322
| | - Shelly Sandeep
- Emory University Hospital Midtown, Medical Office Tower, 9th Floor Voice Center, 550 Peachtree St. NE, Atlanta, GA 30308
| | - Amanda Gillespie
- Emory University Hospital Midtown, Medical Office Tower, 9th Floor Voice Center, 550 Peachtree St. NE, Atlanta, GA 30308
| | - Andrew Tkaczuk
- Emory University Hospital Midtown, Medical Office Tower, 9th Floor Voice Center, 550 Peachtree St. NE, Atlanta, GA 30308,Corresponding Author: Andrew T. Tkaczuk, Emory University School of Medicine, Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, Emory University Hospital Midtown, Medical Office Tower, 9th Floor Voice Center, 550 Peachtree St. NE, Atlanta, GA 30308, Tell: 404-778-3381, Fax: 404-686-4699
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4
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So RJ, Kavookjian H, Ben Or E, Snow GE, Akst LM, Hillel AT, Best SRA. Posterior Glottic Injury Following Prolonged Intubation in COVID-19 Patients. Otolaryngol Head Neck Surg 2023; 168:372-376. [PMID: 35998042 PMCID: PMC9947184 DOI: 10.1177/01945998221120005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/13/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to characterize the risk factors for posterior glottic injury (PGI) in patients with coronavirus disease 2019 (COVID-19) who underwent prolonged intubation. STUDY DESIGN This was a case-control study designed to assess the risk factors associated with development of PGI in COVID-19 patients who underwent prolonged intubation. SETTING This single-center study was conducted at a tertiary care academic hospital in a metropolitan area. METHODS We retrospectively reviewed patients who underwent prolonged intubation (≥7 days) for COVID-19 and compared those with PGI to those without. Patient demographics, comorbidities, and intubation characteristics were compared. Factors associated with PGI development among COVID-19 patients were assessed using multivariate regression. RESULTS We identified 56 patients who presented with PGI following prolonged intubation for COVID-19 and 60 control patients who underwent prolonged intubation for COVID-19 but did not develop PGI. On univariate analyses, the number of reintubations due to failed extubation efforts was significantly associated with development of PGI (odds ratio [OR], 2.9; 95% CI, 1.4-6.2). On multivariate analyses, patients with cardiovascular disease (OR, 3.3; 95% CI, 1.2-9.0); non-COVID-19 respiratory illnesses, which included obstructive sleep apnea and asthma (OR, 5.9; 95% CI, 2.0-17.8); and diabetes mellitus (OR, 11.6; 95% CI, 3.7-36.6) were more likely to develop PGI. CONCLUSION Our results represent the largest case-control study investigating risk factors for PGI in the setting of prolonged intubation specific to COVID-19. Our study suggests a significant role of comorbidities associated with poor wound healing with development of PGI.
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Affiliation(s)
- Raymond J So
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hannah Kavookjian
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Esther Ben Or
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Grace E Snow
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Simon R A Best
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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5
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Clinical profile and recovery pattern of dysphagia in the COVID-19 patient: A prospective observational cohort within NSW. Aust Crit Care 2023; 36:262-268. [PMID: 35177342 PMCID: PMC8758281 DOI: 10.1016/j.aucc.2022.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 12/22/2021] [Accepted: 01/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The impact of COVID-19 on swallowing function is not well understood. Despite low hospital admission rates in Australia, the virus and subsequent treatment affects swallow function in those requiring intensive care unit (ICU) treatment. As such, the current pandemic provides a unique opportunity to describe swallowing function and outline dysphagia characteristics and trajectory of recovery for a series of cases across NSW. AIM The aims of this study were to describe (i) physiological characteristics of swallowing dysfunction and (ii) pattern of swallowing recovery and outcomes, in ICU patients with COVID-19. METHODS All patients admitted to 17 participating NSW Health ICU sites over a 12-month period (March 2020-March 2021), diagnosed with COVID-19, treated with the aim for survival, and seen by a speech pathologist for clinical swallowing examination during hospital admission were considered for inclusion. Demographic, critical care airway management, speech pathology treatment, and swallowing outcome data were collected. RESULTS Twenty-seven patients (22 male; 5 female) with a median age of 65 years (interquartile range [IQR] = 15.5) were recruited. All required mechanical ventilation. Almost 90% of the total cohort had pre-existing comorbidities, with the two most frequently observed being diabetes (63%, 95% confidence interval = 44%-78%) and cardiac disease (59%, 95% confidence interval = 40%-75%) in origin. Prevalence of dysphagia was 93%, with the majority (44%) exhibiting profound dysphagia at the initial assessment. Median duration to initiate oral feeding was 38.5 days (IQR = 31.25) from ICU admission, and 33% received dysphagia rehabilitation. Dysphagia recovery was observed in 81% with a median duration of 44 days (IQR = 29). Positive linear associations were identified between duration of intubation, mechanical ventilation, hospital and ICU length of stay, and the duration to speech pathology assessment (p < 0.005), dysphagia severity (p < 0.002), commencing oral intake (p < 0.02), dysphagia recovery (p < 0.004), and enteral feeding (p < 0.024). CONCLUSION COVID-19 considerably impacted swallowing function in the current study. Although many patients recovered within an acceptable timeframe, some experienced persistent severe dysphagia and a protracted recovery with dependence on enteral nutrition.
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6
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Vance D, Shah P, Sataloff RT. COVID-19: Impact on the Musician and Returning to Singing; A Literature Review. J Voice 2023; 37:292.e1-292.e8. [PMID: 33583675 PMCID: PMC7808728 DOI: 10.1016/j.jvoice.2020.12.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to review current literature of the impact of COVID-19 on musicians and returning to singing. METHODS A comprehensive search of peer-review articles was completed using PubMed, GoogleScholar, Scopus, and Web of Science. The search was completed using many key terms including voice, hoarseness, dysphonia, aphonia, cough, singers, and public speakers. The bibliography from each article found was searched to find additional articles. The search process revealed 56 peer-reviewed articles, 18 primary articles, ranging from the years 2019 to 2020. CONCLUSION COVID-19 has had a major impact on singers and other musicians worldwide. It can affect the voice and can lead to paresis/paralysis of laryngeal nerves to long-term changes in respiratory function. There is a risk from aerosolization/droplet formation transmission with singing, and with playing wind and brass instruments that can be mitigated by following COVID-19 guidelines. Ways to reduce possible transmission during singing and instrument play include virtual rehearsals or performances, mask-wearing, instrument covers, smaller choirs, performing outside, excellent ventilation being socially distanced, shorter rehearsals, regularly cleaning commonly touched surfaces and washing hands, avoiding contact with others, and temperature screening.
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Affiliation(s)
- Dylan Vance
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Priyanka Shah
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
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7
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Potter T, Cronin JN, Kua J, Nurmi E, Wong DJN, Ahmad I, Cook TM, El-Boghdadly K. Aerosol precautions and airway complications: a national prospective multicentre cohort study. Anaesthesia 2023; 78:23-35. [PMID: 36070622 PMCID: PMC10087829 DOI: 10.1111/anae.15851] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/13/2022]
Abstract
The perceived risk of transmission of aerosolised viral particles from patients to airway practitioners during the COVID-19 pandemic led to the widespread use of aerosol precautions, including personal protective equipment and modifications to anaesthetic technique. The risk of these aerosol precautions on peri-operative airway complications has not been assessed outside of simulation studies. This prospective, national, multicentre cohort study aimed to quantify this risk. Adult patients undergoing general anaesthesia for elective or emergency procedures over a 96-hour period were included. Data collected included use of aerosol precautions by the airway practitioner, airway complications and potential confounding variables. Mixed-effects logistic regression was used to assess the risk of individual aerosol precautions on overall and specific airway complications. Data from 5905 patients from 70 hospital sites were included. The rate of airway complications was 10.0% (95%CI 9.2-10.8%). Use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications (odds ratio 1.38, 95%CI 1.04-1.83), predominantly due to an association with difficult facemask ventilation (odds ratio 1.68, 95%CI 1.09-2.61) and desaturation on pulse oximetry (odds ratio 2.39, 95%CI 1.26-4.54). Use of goggles, powered air-purifying respirators, long-sleeved gowns, double gloves and videolaryngoscopy were not associated with any alteration in the risk of airway complications. Overall, the use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications, but most aerosol precautions used during the COVID-19 pandemic were not.
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Affiliation(s)
- T Potter
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - J N Cronin
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - J Kua
- Surgical Outcomes Research Centre, University College London, UK
| | - E Nurmi
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - D J N Wong
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - I Ahmad
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,King's College London, UK
| | - T M Cook
- Department of Anaesthesia, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,School of Medicine, University of Bristol, UK
| | - K El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,King's College London, UK
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Abstract
The German Society of Pneumology initiated 2021 the AWMF S1 guideline Long COVID/Post-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendations describe current Long COVID/Post-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an explicit practical claim and will be developed and adapted by the author team based on the current increase in knowledge.
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Miles A, McRae J, Clunie G, Gillivan-Murphy P, Inamoto Y, Kalf H, Pillay M, Pownall S, Ratcliffe P, Richard T, Robinson U, Wallace S, Brodsky MB. An International Commentary on Dysphagia and Dysphonia During the COVID-19 Pandemic. Dysphagia 2022; 37:1349-1374. [PMID: 34981255 PMCID: PMC8723823 DOI: 10.1007/s00455-021-10396-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/01/2021] [Indexed: 12/16/2022]
Abstract
COVID-19 has had an impact globally with millions infected, high mortality, significant economic ramifications, travel restrictions, national lockdowns, overloaded healthcare systems, effects on healthcare workers' health and well-being, and large amounts of funding diverted into rapid vaccine development and implementation. Patients with COVID-19, especially those who become severely ill, have frequently developed dysphagia and dysphonia. Health professionals working in the field have needed to learn about this new disease while managing these patients with enhanced personal protective equipment. Emerging research suggests differences in the clinical symptoms and journey to recovery for patients with COVID-19 in comparison to other intensive care populations. New insights from outpatient clinics also suggest distinct presentations of dysphagia and dysphonia in people after COVID-19 who were not hospitalized or severely ill. This international expert panel provides commentary on the impact of the pandemic on speech pathologists and our current understanding of dysphagia and dysphonia in patients with COVID-19, from acute illness to long-term recovery. This narrative review provides a unique, comprehensive critical appraisal of published peer-reviewed primary data as well as emerging previously unpublished, original primary data from across the globe, including clinical symptoms, trajectory, and prognosis. We conclude with our international expert opinion on what we have learnt and where we need to go next as this pandemic continues across the globe.
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Affiliation(s)
- Anna Miles
- Speech Science, School of Psychology, The University of Auckland, Grafton Campus, Private Bag 92019, Auckland, New Zealand.
| | - Jackie McRae
- Centre for Allied Health, St George's, University of London/University College London Hospitals NHS Foundation Trust, London, UK
| | - Gemma Clunie
- Imperial College London & Clinical Specialist SLT (Airways/ENT), Imperial College Healthcare NHS Trust, London, UK
| | - Patricia Gillivan-Murphy
- Clinical Specialist SLT, Voice & Swallowing Clinic, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Yoko Inamoto
- SLHT, Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Hanneke Kalf
- Division of Speech Pathology, Department of Rehabilitation, Radboud University Medical Centre / Donders Centre for Neuroscience, Nijmegen, The Netherlands
| | - Mershen Pillay
- Speech-Language Therapy, University of KwaZulu-Natal, Durban, South Africa
| | - Susan Pownall
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Philippa Ratcliffe
- Consultant SLT Royal National ENT and EDH University College London Hospitals NHS Foundation Trust, London, UK
| | - Theresa Richard
- Mobile Dysphagia Diagnostics, Medical SLP Collective, Buffalo, USA
| | - Ursula Robinson
- SLT, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - Sarah Wallace
- Consultant SLT, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Martin B Brodsky
- Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
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10
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Boggiano S, Williams T, Gill SE, Alexander PDG, Khwaja S, Wallace S, McGrath BA. Multidisciplinary management of laryngeal pathology identified in patients with COVID-19 following trans-laryngeal intubation and tracheostomy. J Intensive Care Soc 2022; 23:425-432. [PMID: 36751349 PMCID: PMC9679906 DOI: 10.1177/17511437211034699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background COVID-19 disease often requires invasive ventilatory support. Trans-laryngeal intubation of the trachea may cause laryngeal injury, possibly compounded by coronavirus infection. Fibreoptic Endoscopic Evaluation of Swallowing (FEES) provides anatomical and functional assessment of the larynx, guiding multidisciplinary management. Our aims were to observe the nature of laryngeal abnormalities in patients with COVID-19 following prolonged trans-laryngeal intubation and tracheostomy, and to describe their impact on functional laryngeal outcomes, such as tracheostomy weaning. Methods A retrospective observational cohort analysis was undertaken between March and December 2020, at a UK tertiary hospital. The Speech and Language Therapy team assessed patients recovering from COVID-19 with voice/swallowing problems identified following trans-laryngeal intubation or tracheostomy using FEES. Laryngeal pathology, treatments, and outcomes relating to tracheostomy and oral feeding were noted. Results Twenty-five FEES performed on 16 patients identified a median of 3 (IQR 2-4) laryngeal abnormalities, with 63% considered clinically significant. Most common pathologies were: oedema (n = 12, 75%); abnormal movement (n = 12, 75%); atypical lesions (n = 11, 69%); and erythema (n = 6, 38%). FEES influenced management: identifying silent aspiration (88% of patients who aspirated (n = 8)), airway patency issues impacting tracheostomy weaning (n = 8, 50%), targeted dysphagia therapy (n = 7, 44%); ENT referral (n = 6, 38%) and reflux management (n = 5, 31%). Conclusions FEES is beneficial in identifying occult pathologies and guiding management for laryngeal recovery. In our cohort, the incidence of laryngeal pathology was higher than a non-COVID-19 cohort with similar characteristics. We recommend multidisciplinary investigation and management of patients recovering from COVID-19 who required prolonged trans-laryngeal intubation and/or tracheostomy to optimise laryngeal recovery.
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Affiliation(s)
- Sarah Boggiano
- Department of Speech, Voice and Swallowing, Wythenshawe
Hospital, Wythenshawe, UK,Manchester University NHS Foundation Trust, Manchester, UK
| | - Thomas Williams
- University Hospitals of Morecambe Bay NHS Foundation Trust,
Lancaster, UK,Thomas Williams, University Hospitals of
Morecambe Bay NHS Foundation Trust, Lancaster, UK.
| | - Sonya E Gill
- Manchester University NHS Foundation Trust, Manchester, UK,Acute Intensive Care Unit, Wythenshawe Hospital, Wythenshawe,
UK
| | - Peter DG Alexander
- Manchester University NHS Foundation Trust, Manchester, UK,Acute Intensive Care Unit, Wythenshawe Hospital, Wythenshawe,
UK,Manchester Academic Critical Care, Division of Infection,
Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of
Biology, Medicine and Health, the University of Manchester, Manchester Academic
Health Science Centre, Manchester, UK
| | - Sadie Khwaja
- Manchester University NHS Foundation Trust, Manchester, UK,Department of Head & Neck Surgery, Wythenshawe Hospital,
Wythenshawe, UK
| | - Sarah Wallace
- Department of Speech, Voice and Swallowing, Wythenshawe
Hospital, Wythenshawe, UK,Manchester University NHS Foundation Trust, Manchester, UK,Acute Intensive Care Unit, Wythenshawe Hospital, Wythenshawe,
UK
| | - Brendan A McGrath
- Manchester University NHS Foundation Trust, Manchester, UK,Acute Intensive Care Unit, Wythenshawe Hospital, Wythenshawe,
UK,Manchester Academic Critical Care, Division of Infection,
Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of
Biology, Medicine and Health, the University of Manchester, Manchester Academic
Health Science Centre, Manchester, UK
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11
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Puthucheary ZA, Rice TW. Nutritional priorities in patients with severe COVID-19. Curr Opin Clin Nutr Metab Care 2022; 25:277-281. [PMID: 35703977 PMCID: PMC9247039 DOI: 10.1097/mco.0000000000000835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic has altered the profile of critical care services internationally, as professionals around the globe have struggled to rise to the unprecedented challenge faced, both in terms of individual patient management and the sheer volume of patients that require treatment and management in intensive care. This review article sets out key priorities in nutritional interventions during the patient journey, both in the acute and recovery phases. RECENT FINDINGS The current review covers the care of the acutely unwell patient, and the evidence base for nutritional interventions in the COVID-19 population. One of the biggest differences in caring for critically ill patients with acute respiratory failure from COVID-19 is often the time prior to intubation. This represents specific nutritional challenges, as does nursing patients in the prone position or in the setting of limited resources. This article goes on to discuss nutritional support for COVID-19 sufferers as they transition through hospital wards and into the community. SUMMARY Nutritional support of patients with severe COVID-19 is essential. Given the longer duration of their critical illness, combined with hypermetabolism and energy expenditure, patients with COVID-19 are at increased risk for malnutrition during and after their hospital stay.
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Affiliation(s)
- Zudin A Puthucheary
- William Harvey Research Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London
- Adult Critical Care Unit, Royal London Hospital, London, UK
| | - Todd W Rice
- Vanderbilt Institute for Clinical and Translational Research
- Division of Allergy, Department of Medicine, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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12
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Ward PA, Baker M, Glarbo S, Hill A, Gandhi A, Sokhi J, Lockie C. Emergency intubation in COVID-19 positive patients: Comparison of pandemic surges at a UK center. Acute Crit Care 2022; 37:263-265. [PMID: 35698766 PMCID: PMC9184975 DOI: 10.4266/acc.2021.01655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
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13
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The Ethics of Procedural Education Under Pandemic Conditions. J Emerg Med 2022; 62:685-689. [PMID: 35400508 PMCID: PMC8989265 DOI: 10.1016/j.jemermed.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/23/2022]
Abstract
Background: The COVID-19 pandemic significantly disrupted emergency medicine residents’ education. Early in the pandemic, many facilities lacked adequate personal protective equipment (PPE), and intubation was considered particularly high risk for transmission to physicians, leading hospitals to limit the number of individuals present during the procedure. This posed difficulties for residents and academic faculty, as opportunities to perform endotracheal intubation during residency are limited, but patients with COVID-19 requiring intubation are unstable and have difficult airways. Case Scenario: When PPE is being rationed, who should be the one to perform an intubation on a patient with respiratory failure from severe COVID-19? Discussion: We examined this case scenario using the ethical frameworks of bioethical principles and virtue ethics. Bioethical principles include justice, beneficence, nonmalfeasance, and autonomy, and virtue ethics emphasizes the provision of moral exemplars and opportunities to exercise practical wisdom. Arguments for an attending-only strategy include the role of the attending as a truly autonomous decision maker and the importance of providing residents with a moral exemplar. A resident-only strategy benefits a resident's future patients and provides opportunities for residents to exercise character. Strategies preserving the dyad of attending and resident maintain these advantages and mitigate some drawbacks, while intubation teams may provide the most parsimonious use of PPE, but may elide resident involvement. Conclusions: There exist compelling motivations for involving senior residents and attendings in high-risk intubations during the COVID-19 pandemic. A just strategy will preserve residents’ role whenever possible, while maximizing supervision and providing alternative routes for intubation practice.
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14
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Almendra M, Pereira MP, Gonçalves CS, Bonfadini M, Brites V, Estrada JF. Croup and COVID-19. J Paediatr Child Health 2022; 58:1691-1692. [PMID: 35429196 PMCID: PMC9115154 DOI: 10.1111/jpc.15987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/26/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Margarida Almendra
- Pediatric Intensive Care Unit, Hospital Dona EstefâniaCentro Hospitalar Universitário Lisboa Central, EPELisbonPortugal
| | - Miguel Paiva Pereira
- Pediatric Intensive Care Unit, Hospital Dona EstefâniaCentro Hospitalar Universitário Lisboa Central, EPELisbonPortugal
| | - Catarina Santiago Gonçalves
- Pediatric Intensive Care Unit, Hospital Dona EstefâniaCentro Hospitalar Universitário Lisboa Central, EPELisbonPortugal
| | - Marcia Bonfadini
- Pediatric Intensive Care Unit, Hospital Dona EstefâniaCentro Hospitalar Universitário Lisboa Central, EPELisbonPortugal
| | - Vera Brites
- Pediatric Intensive Care Unit, Hospital Dona EstefâniaCentro Hospitalar Universitário Lisboa Central, EPELisbonPortugal
| | - João Falcão Estrada
- Pediatric Intensive Care Unit, Hospital Dona EstefâniaCentro Hospitalar Universitário Lisboa Central, EPELisbonPortugal
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15
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Fiacchini G, Proietti A, Poma AM, Picariello M, Dallan I, Guarracino F, Forfori F, Fontanini G, Bruschini L. Inflammatory Profiles of Tracheal Biopsies From SARS-CoV-2 Patients. Front Microbiol 2022; 13:851460. [PMID: 35369457 PMCID: PMC8966427 DOI: 10.3389/fmicb.2022.851460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/11/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose An increasing number of laryngotracheal complications in mechanically ventilated COVID-19 patients has been reported in the last few months. Many etiopathogenetic hypotheses were proposed but no clear explanation of these complications was identified. In this paper we evaluated the possibility that the tracheal mucosa could be a high viral replication site that could weaken the epithelium itself. Methods Subjects for the COVID-19 group and the control group were selected retrospectively according to specific criteria. Patients’ basic and clinical data were recorded and analyzed. Tracheal samples of both groups were collected during surgical tracheostomies and then analyzed from a histological and genetic-transcriptional point of view. Results Four COVID-19 patients were enrolled in this study and compared with four non-COVID-19 patients. No laryngotracheal complications were identified in both groups. The SARS-CoV-2 was detected in one out of four COVID-19 samples. A subepithelial inflammatory lymphomonocyte infiltrate was observed in all patients but two cases of the COVID-19 group showed vasculitis of small subepithelial vessels associated with foci of coagulative necrosis. Two gene sets (HALLMARK_INFLAMMATORY_RESPONSE and HALLMARK_ESTROGEN_RESPONSE_LATE) were significantly deregulated in COVID-19 patients compared to the control group. Conclusion The altered inflammatory response of the COVID-19 patients could be another possible explanation of the increasing number of laryngotracheal complications.
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Affiliation(s)
- Giacomo Fiacchini
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Agnese Proietti
- Unit of Pathological Anatomy, University Hospital of Pisa, Pisa, Italy
| | - Anello Marcello Poma
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Miriana Picariello
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Iacopo Dallan
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Fabio Guarracino
- Cardiothoracic and Vascular Anaesthesia and Intensive Care, Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Francesco Forfori
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Gabriella Fontanini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Luca Bruschini
- Otolaryngology, Audiology and Phoniatric Operative Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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16
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Allisan‐Arrighi AE, Rapoport SK, Laitman BM, Bahethi R, Mori M, Woo P, Genden E, Courey M, Kirke DN. Long‐term upper aerodigestive sequelae as a result of infection with
COVID
‐19. Laryngoscope Investig Otolaryngol 2022; 7:476-485. [PMID: 35434347 PMCID: PMC9008172 DOI: 10.1002/lio2.763] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/06/2021] [Accepted: 01/31/2022] [Indexed: 01/14/2023] Open
Abstract
Objectives Respiratory, voice, and swallowing difficulties after severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) may result secondary to upper airway disease from prolonged intubation or mechanisms related to the virus itself. We examined a cohort who presented with new laryngeal complaints following documented SARS‐CoV‐2 infection. We characterized their voice, airway, and/or swallowing symptoms and reviewed the clinical course of their complaints to understand how the natural history of these symptoms relates to COVID‐19 infections. Methods Retrospective review of patients who presented to our department with upper aerodigestive complaints as sequelae of prior infection with, and management of, SARS‐CoV‐2. Results Eighty‐one patients met the inclusion criteria. Median age was 54.23 years (±17.36). Most common presenting symptoms were dysphonia (n = 58, 71.6%), dysphagia/odynophagia (n = 16, 19.75%), and sore throat (n = 9, 11.11%). Thirty‐one patients (38.27%) presented after intubation. Mean length of intubation was 16.85 days (range 1–35). Eighteen patients underwent tracheostomy and were decannulated after an average of 70.69 days (range 23–160). Patients with history of intubation were significantly more likely than nonintubated patients to be diagnosed with a granuloma (8 vs. 0, respectively, p < .01). Fifty patients (61.73%) were treated for SARS‐CoV‐2 without requiring intubation and were significantly more likely to be diagnosed with muscle tension dysphonia (19 vs. 1, p < .01) and laryngopharyngeal reflux (18 vs. 1, p < .01). Conclusion In patients with persistent dyspnea, dysphonia, or dysphagia after recovering from SARS‐CoV‐2, early otolaryngology consultation should be considered. Accurate diagnosis and prompt management of these common underlying etiologies may improve long‐term patient outcomes. Level of evidence 4
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Affiliation(s)
- Annie E. Allisan‐Arrighi
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Sarah K. Rapoport
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Benjamin M. Laitman
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Rohini Bahethi
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Matthew Mori
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Peak Woo
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Eric Genden
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Mark Courey
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Diana N. Kirke
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
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17
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Clunie GM, Bolton L, Lovell L, Bradley E, Bond C, Bennington S, Roe J. Considerations for speech and language therapy management of dysphagia in patients who are critically ill with COVID-19: a single centre case series. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Patients treated with intubation and tracheostomy for COVID-19 infection are at risk of increased incidence of laryngeal injury, dysphagia and dysphonia. Because of the novelty of the SARS-CoV-2 virus, little is known about the type of dysphagia patients experience as a result of infection and critical illness. The aim of this case series report was to progress understanding of COVID-19 and dysphagia following admission to an intensive care unit and to guide speech and language therapy clinical practice in the ongoing pandemic. Methods A retrospective case review was conducted of all patients at Imperial College Healthcare NHS Trust, London who underwent a tracheostomy because of COVID-19 and received an instrumental assessment of swallowing in the early stages of the pandemic. Results A total of 11 patients were identified, and descriptive statistics were used to present demographic data, with a narrative account of their dysphagia profile used to describe presentation. Causes and presentation of dysphagia were heterogenous, with each patient requiring individualised clinical management to maximise outcome. A positive trend was seen in terms of recovery trajectory and progressing to oral intake. Conclusions This study reports on early experience of the presentation of dysphagia in patients with COVID-19 and demonstrates the value of instrumental assessment. It indicates the need for further research to consolidate knowledge and guide clinical practice.
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Affiliation(s)
- Gemma M Clunie
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lee Bolton
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Lindsay Lovell
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth Bradley
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Cara Bond
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Sarah Bennington
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Justin Roe
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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18
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Notkoniotomie bei einem COVID-19-Patienten nach vorangegangener nichtinvasiver Beatmung. ANÄSTHESIE NACHRICHTEN 2022. [PMCID: PMC8832081 DOI: 10.1007/s44179-022-00006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Hernandez G, Ramos FJ, Añon JM, Ortiz R, Colinas L, Masclans JR, De Haro C, Ortega A, Peñuelas O, Cruz-Delgado MDM, Canabal A, Plans O, Vaquero C, Rialp G, Gordo F, Lesmes A, Martinez M, Figueira JC, Gomez-Carranza A, Corrales R, Castellvi A, Castiñeiras B, Frutos-Vivar F, Prada J, De Pablo R, Naharro A, Montejo JC, Diaz C, Santos-Peral A, Padilla R, Marin-Corral J, Rodriguez-Solis C, Sanchez-Giralt JA, Jimenez J, Cuena R, Perez-Hoyos S, Roca O. Early Tracheostomy for Managing ICU Capacity During the COVID-19 Outbreak: A Propensity-Matched Cohort Study. Chest 2022; 161:121-129. [PMID: 34147502 PMCID: PMC8361308 DOI: 10.1016/j.chest.2021.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND During the first wave of the COVID-19 pandemic, shortages of ventilators and ICU beds overwhelmed health care systems. Whether early tracheostomy reduces the duration of mechanical ventilation and ICU stay is controversial. RESEARCH QUESTION Can failure-free day outcomes focused on ICU resources help to decide the optimal timing of tracheostomy in overburdened health care systems during viral epidemics? STUDY DESIGN AND METHODS This retrospective cohort study included consecutive patients with COVID-19 pneumonia who had undergone tracheostomy in 15 Spanish ICUs during the surge, when ICU occupancy modified clinician criteria to perform tracheostomy in Patients with COVID-19. We compared ventilator-free days at 28 and 60 days and ICU- and hospital bed-free days at 28 and 60 days in propensity score-matched cohorts who underwent tracheostomy at different timings (≤ 7 days, 8-10 days, and 11-14 days after intubation). RESULTS Of 1,939 patients admitted with COVID-19 pneumonia, 682 (35.2%) underwent tracheostomy, 382 (56%) within 14 days. Earlier tracheostomy was associated with more ventilator-free days at 28 days (≤ 7 days vs > 7 days [116 patients included in the analysis]: median, 9 days [interquartile range (IQR), 0-15 days] vs 3 days [IQR, 0-7 days]; difference between groups, 4.5 days; 95% CI, 2.3-6.7 days; 8-10 days vs > 10 days [222 patients analyzed]: 6 days [IQR, 0-10 days] vs 0 days [IQR, 0-6 days]; difference, 3.1 days; 95% CI, 1.7-4.5 days; 11-14 days vs > 14 days [318 patients analyzed]: 4 days [IQR, 0-9 days] vs 0 days [IQR, 0-2 days]; difference, 3 days; 95% CI, 2.1-3.9 days). Except hospital bed-free days at 28 days, all other end points were better with early tracheostomy. INTERPRETATION Optimal timing of tracheostomy may improve patient outcomes and may alleviate ICU capacity strain during the COVID-19 pandemic without increasing mortality. Tracheostomy within the first work on a ventilator in particular may improve ICU availability.
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Affiliation(s)
- Gonzalo Hernandez
- Intensive Care Unit, University Hospital Virgen de la Salud, Toledo, Spain.
| | | | - José Manuel Añon
- Intensive Care Unit, La Paz University Hospital, Madrid, Spain; Ciber Enfermedades Respiratorias (CIBERES), Health Institute Carlos III, Madrid, Spain
| | - Ramón Ortiz
- Intensive Care Unit, Ciudad Real University Hospital, Ciudad Real, Sabadell, Spain
| | - Laura Colinas
- Intensive Care Unit, University Hospital Virgen de la Salud, Toledo, Spain
| | - Joan Ramón Masclans
- Intensive Care Unit, Del Mar University Hospital, Barcelona, Spain; Mar Medical Research Institute, UPF, Departament de Ciències Experimentals i de la Salut-DCEXS, Barcelona, Spain
| | | | - Alfonso Ortega
- Intensive Care Unit, Puerta de Hierro University Hospital, Madrid, Spain
| | - Oscar Peñuelas
- Intensive Care Unit, Getafe University Hospital, Madrid, Spain
| | | | - Alfonso Canabal
- Intensive Care Unit, La Princesa University Hospital, Madrid, Spain
| | - Oriol Plans
- Intensive Care Unit, Joan XXIII University Hospital, Tarragona, Spain
| | | | - Gemma Rialp
- Intensive Care Unit, Son Llatzer University Hospital, Mallorca, Spain
| | - Federico Gordo
- Intensive Care Unit, Henares University Hospital, Madrid, Spain; Universidad Francisco de Vitoria, Madrid, Spain
| | - Amanda Lesmes
- Intensive Care Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - María Martinez
- Intensive Care Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Rocio Corrales
- Department of Otolaryngology-Head and Neck Surgery, University Hospital Virgen de la Salud, Toledo, Spain
| | - Andrea Castellvi
- Intensive Care Unit, Del Mar University Hospital, Barcelona, Spain
| | | | | | - Jorge Prada
- Department of Otolaryngology-Head and Neck Surgery, La Princesa University Hospital, Madrid, Spain
| | - Raul De Pablo
- Intensive Care Unit, Ramón y Cajal University Hospital, Madrid, Spain; Critical Care Department, Alcala de Henares University, Alcala de Henares, Spain
| | - Antonio Naharro
- Intensive Care Unit, Henares University Hospital, Madrid, Spain
| | | | - Claudia Diaz
- Intensive Care Unit, La Paz University Hospital, Madrid, Spain
| | - Alfonso Santos-Peral
- Intensive Care Unit, Ciudad Real University Hospital, Ciudad Real, Sabadell, Spain
| | - Rebeca Padilla
- Intensive Care Unit, University Hospital Virgen de la Salud, Toledo, Spain
| | | | | | | | - Jorge Jimenez
- Intensive Care Unit, Getafe University Hospital, Madrid, Spain
| | | | - Santiago Perez-Hoyos
- Statistics and Bioinformatics Unit, Vall d'Hebron Research Institute, Barcelona, Spain; IDIBAPS, the Genetics, Microbiology and Statistics Department, University of Barcelona, Barcelona, Spain
| | - Oriol Roca
- Intensive Care Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Ciber Enfermedades Respiratorias (CIBERES), Health Institute Carlos III, Madrid, Spain
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20
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D'Amore J, Meigher S, Patterson E, Sanapala S, Tarr M, Leisman D, Jones M, Moskovitz JB, Offenbacher J, Sperling J. Intubation outcomes and practice trends during the initial New York SARS-COV-19 surge at an academic, level 1 trauma, urban emergency department. J Am Coll Emerg Physicians Open 2021; 2:e12563. [PMID: 34853833 PMCID: PMC8612629 DOI: 10.1002/emp2.12563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/02/2021] [Accepted: 08/30/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The goal of this study was to describe outcomes and associated characteristics of patients who were intubated during the initial (3/2020-4/2020) New York City surge of the severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic, during which time we were confronted by an unknown and unprecedented respiratory distress syndrome with extremely high degrees of morbidity and mortality. Our secondary aim was to analyze our physician's rapidly evolving approaches to COVID-19 airway management. METHODS A retrospective cohort analysis of all patients intubated at two emergency departments (EDs) for COVID-19 suspected respiratory failure. In addition, a survey was done to analyze clinician airway management trends and attitudes as they evolved during that period. RESULTS Ninety-five patients met inclusion criteria for the study. Primary outcomes looked at the spectrum of mortality outcomes ranging from died on arrival (DOA) to the ED, died in the ED (DED), died an inpatient (DIH), and survival to discharge. Overall mortalitywas 71.6% with an average age of 62.7 years. Female sex, as a demographic, was associated with higher rates of survival to discharge at 42.3% when compared to males at 23.2% (P < 0.001). Mean age was 70.8 years DOA, 65.6 years DED, 62.9 years DIH, and 60.0 years for survivors (P = 0.0037). Initial lactate levels were 8.15 mmol/L DED, 3.56 mmol/L DIH, and 2.61 mmol/L survivors (P < 0.0001). Initial creatinine levels were 3.38 mg/dL DED, 1.94 mg/dL DIH, and 1.77 mg/dL survivors (P = 0.0073). D-dimer levels were 7520.5 ng/mL DED, 5932.4 ng/mL DIH, and 1133.9 ng/mL survivors (P = 0.0045). Physician survey respondents reported high levels (69%) of laryngeal edema and prolonged post intubation hypoxia (>50% of time) and >80% remained concerned for their safety. There was a dramatic shift from early (73% of time) to late intubation strategies (67% of time) or non-invasive approaches (28% of time) as the first surge of the pandemic evolved. CONCLUSION Our findings demonstrate that several demographic, clinical and laboratory parameters correlated with mortality in our cohort of patients intubated during the initial phase of the COVID-19 pandemic. These included male sex, advanced age, high levels of initial lactic acidosis, elevated D-dimer, and chronic kidney disease/acute kidney injury. In contrast, presenting respiratory characteristics were not correlated with mortality. In addition, our findings demonstrate that physician attitudes and strategies related to COVID-19 airway management evolved significantly and rapidly over the initial phase of the pandemic.
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Affiliation(s)
- Jason D'Amore
- Department of Emergency Medicine at the Jacobi Medical CenterAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Stephen Meigher
- Department of Emergency Medicine at the Jacobi and Montefiore Medical CentersAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Elizabeth Patterson
- Department of Emergency Medicine at the Jacobi and Montefiore Medical CentersAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Sowmya Sanapala
- Department of Emergency Medicine at the Jacobi and Montefiore Medical CentersAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Michael Tarr
- Department of Emergency Medicine at the Jacobi and Montefiore Medical CentersAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Dan Leisman
- Icahn Mount Sinai School of MedicineNew YorkNew YorkUSA
| | - Michael Jones
- Department of Emergency Medicine at the Jacobi and Montefiore Medical CentersAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Joshua B Moskovitz
- Department of Emergency Medicine at the Jacobi Medical CenterAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Joseph Offenbacher
- Department of Emergency Medicine at the Jacobi and Montefiore Medical CentersAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Jeremy Sperling
- Department of Emergency Medicine at the Jacobi Medical CenterAlbert Einstein College of MedicineBronxNew YorkUSA
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21
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Ward PA, Collier JM, Weir J, Osborn M, Hanley B, Smellie WJB. Histological findings of tracheal samples from COVID-19 positive critically ill mechanically ventilated patients. Clin Otolaryngol 2021; 47:131-137. [PMID: 34606150 PMCID: PMC8653284 DOI: 10.1111/coa.13872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/15/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022]
Abstract
Objectives This study examines the histological findings of tracheal tissue samples obtained from COVID‐19 positive mechanically ventilated patients, to assess the degree of tracheal inflammation/ulceration present. Design and participants Retrospective single‐centre observational cohort study. All patients admitted to Adult Intensive Care Unit (AICU) with COVID‐19 infection, requiring mechanical ventilation and surgical tracheostomy between 1 April and 1 May 2020, were included (Group 1). Tracheal windows excised at tracheostomy underwent histological analysis. Comparison was made with: tracheal windows from COVID‐19 positive AICU ventilated patients admitted between 1 January and 1 March 2021 (Group 2); tracheal windows from COVID‐19 negative AICU ventilated patients (Group 3); and, tracheal autopsy samples from COVID‐19 positive patients that died without undergoing prolonged mechanical ventilation (Group 4). Results Group 1 demonstrated mild/moderate inflammation (tracheitis) in nearly all samples (15/16, 93.8%), with infrequent micro‐ulceration (2/16, 12.5%). Group 2 demonstrated similar mild/moderate inflammation in all samples (17/17, 100%), with no ulceration. Histological findings of Groups 1 and 2 COVID‐19 positive patients were similar to Group 3 COVID‐19 negative patients, which demonstrated mild/moderate inflammation (5/5, 100%), with uncommon superficial erosion (1/5, 20%). Group 4 demonstrated mild chronic inflammation or no significant inflammation, with uncommon micro‐ulceration (1/4, 25%). Conclusions Severe tracheal inflammation was not demonstrated in mechanically ventilated COVID‐19 positive patients at the level of the second/third tracheal rings, at the stage of disease patients underwent tracheostomy. Histological findings were similar between mechanically ventilated COVID‐19 positive and negative patients. Tracheal ulceration may be a feature of early or severe COVID‐19 disease.
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Affiliation(s)
| | - Jonathan Marc Collier
- Department of Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital, London, UK
| | - Justin Weir
- Department of Cellular Pathology, North West London Pathology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Michael Osborn
- Department of Cellular Pathology, North West London Pathology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Brian Hanley
- Department of Cellular Pathology, North West London Pathology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
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22
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Castillo-Allendes A, Contreras-Ruston F, Cantor L, Codino J, Guzman M, Malebran C, Manzano C, Pavez A, Vaiano T, Wilder F, Behlau M. Terapia de voz en el contexto de la pandemia covid-19; recomendaciones para la práctica clínica. J Voice 2021; 35:808.e1-808.e12. [PMID: 32917457 PMCID: PMC7442931 DOI: 10.1016/j.jvoice.2020.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Since the beginning of the new pandemic, COVID-19 health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. OBJECTIVE To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. METHODS A group of 11 experts in voice and swallowing disorders from 5 different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. RESULTS The clinical guide provides 79 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. CONCLUSION This guideline should be taken only as recommendations; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.
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Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Francisco Contreras-Ruston
- Speech-Language Pathology and Audiology Department, Universidad de Valparaíso, San Felipe, Chile,Address correspondence and reprint requests to Francisco Contreras-Ruston, CEV–Centro de Estudos da Voz, Rua Machado Bittencourt, 361, SP 04044-001, Brazil
| | - Lady Cantor
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá, Colombia,Program of Speech and Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Juliana Codino
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan,Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Marco Guzman
- Universidad de los Andes, Chile, Santiago, Chile
| | - Celina Malebran
- Escuela de Fonoaudiología, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Carlos Manzano
- Hospital Médica Sur, Ciudad de México, México,Centro Médico ABC, Ciudad de México, México
| | - Axel Pavez
- Physical Medicine and Rehabilitation Service, Hospital de Urgencia Asistencia Pública. Santiago, Chile
| | - Thays Vaiano
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Fabiana Wilder
- Carrera de Fonoaudiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina,Servicio de Fonoudiología, Hospital de Clínicas “José de San Martin”, Buenos Aires, Argentina
| | - Mara Behlau
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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Castillo-Allendes A, Contreras-Ruston F, Cantor L, Codino J, Guzman M, Malebran C, Manzano C, Pavez A, Vaiano T, Wilder F, Behlau M. Terapia Vocal No Contexto Da Pandemia Do Covid-19; Orientações Para A Prática Clínica. J Voice 2021; 35:808.e13-808.e24. [PMID: 32917460 PMCID: PMC7439998 DOI: 10.1016/j.jvoice.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Since the beginning of the new pandemic, Corona Virus Disease 2019 (COVID-19) health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. OBJECTIVE To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. METHODS A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. RESULT The clinical guide provides 79 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. CONCLUSION This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.
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Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Francisco Contreras-Ruston
- Speech-Language Pathology and Audiology Department, Universidad de Valparaíso, San Felipe, Chile,Address correspondence and reprint requests to Francisco Contreras-Ruston, CEV–Centro de Estudos da Voz, Rua Machado Bittencourt, 361, SP 04044-001, Brazil
| | - Lady Cantor
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá, Colombia,Program of Speech and Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Juliana Codino
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan,Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Marco Guzman
- Universidad de los Andes, Chile, Santiago, Chile
| | - Celina Malebran
- Escuela de Fonoaudiología, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Carlos Manzano
- Hospital Médica Sur, Ciudad de México, México,Centro Médico ABC, Ciudad de México, México
| | - Axel Pavez
- Physical Medicine and Rehabilitation Service, Hospital de Urgencia Asistencia Pública. Santiago, Chile
| | - Thays Vaiano
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Fabiana Wilder
- Carrera de Fonoaudiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina,Servicio de Fonoudiología, Hospital de Clínicas “José de San Martin,” Buenos Aires, Argentina
| | - Mara Behlau
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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Castillo-Allendes A, Contreras-Ruston F, Cantor-Cutiva LC, Codino J, Guzman M, Malebran C, Manzano C, Pavez A, Vaiano T, Wilder F, Behlau M. Voice Therapy in the Context of the COVID-19 Pandemic: Guidelines for Clinical Practice. J Voice 2021; 35:717-727. [PMID: 32878736 PMCID: PMC7413113 DOI: 10.1016/j.jvoice.2020.08.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Since the beginning of the new pandemic, COVID-19 health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. OBJECTIVE To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. METHODS A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. RESULTS The clinical guide provides 65 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. CONCLUSION This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.
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Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | | | - Lady Catherine Cantor-Cutiva
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá, Colombia; Program of Speech and Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Juliana Codino
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan; Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Marco Guzman
- Universidad de los Andes, Chile, Santiago, Chile
| | - Celina Malebran
- Escuela de Fonoaudiología, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Carlos Manzano
- Hospital Médica Sur, Ciudad de México, México; Centro Médico ABC, Ciudad de México, México
| | - Axel Pavez
- Physical Medicine and Rehabilitation Service, Hospital de Urgencia Asistencia Pública. Santiago, Chile
| | - Thays Vaiano
- CEV - Centro de Estudos da Voz, São Paulo, Brazil; Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Fabiana Wilder
- Carrera de Fonoaudiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina; Servicio de Fonoudiología, Hospital de Clínicas "José de San Martin", Buenos Aires, Argentina
| | - Mara Behlau
- CEV - Centro de Estudos da Voz, São Paulo, Brazil; Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2021. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2021 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901 .
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Affiliation(s)
- Thomas Williams
- Academic Foundation Trainee, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - Brendan A McGrath
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
- Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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Neevel AJ, Smith JD, Morrison RJ, Hogikyan ND, Kupfer RA, Stein AP. Postacute COVID-19 Laryngeal Injury and Dysfunction. OTO Open 2021; 5:2473974X211041040. [PMID: 34458661 PMCID: PMC8392819 DOI: 10.1177/2473974x211041040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/12/2021] [Indexed: 01/06/2023] Open
Abstract
Objective Patients with COVID-19 are at risk for laryngeal injury and dysfunction secondary to respiratory failure, prolonged intubation, and other unique facets of this illness. Our goal is to report clinical features and treatment for patients presenting with voice, airway, and/or swallowing concerns postacute COVID-19. Study Design Case series. Setting Academic tertiary care center. Methods Patients presenting with laryngeal issues following recovery from COVID-19 were included after evaluation by our laryngology team. Data were collected via retrospective chart review from March 1, 2020, to April 1, 2021. This included details of the patient’s COVID-19 course, initial presentation to laryngology, and subsequent treatment. Results Twenty-four patients met inclusion criteria. Twenty (83%) patients were hospitalized, and 18 required endotracheal intubation for a median (range) duration of 14 days (6-31). Ten patients underwent tracheostomy. Patients were evaluated at a median 107 days (32-215) after their positive SARS-CoV-2 test result. The most common presenting concerns were dysphonia (n = 19, 79%), dyspnea (n = 17, 71%), and dysphagia (n = 6, 25%). Vocal fold motion impairment (50%), early glottic injury (39%), subglottic/tracheal stenosis (22%), and posterior glottic stenosis (17%) were identified in patients who required endotracheal intubation. Patients who did not need intubation were most frequently treated for muscle tension dysphonia (67%). Conclusion Patients may develop significant voice, airway, and/or swallowing issues postacute COVID-19. These complications are not limited to patients requiring intubation or tracheostomy. Multidisciplinary laryngology clinics will continue to play an integral role in diagnosing and treating patients with COVID-19–related laryngeal sequelae.
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Affiliation(s)
- Andrew J Neevel
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Joshua D Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert J Morrison
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Norman D Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Robbi A Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew P Stein
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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28
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[COVID-19-New challenges in dysphagia and respiratory therapy]. DER NERVENARZT 2021; 93:167-174. [PMID: 34241639 PMCID: PMC8268615 DOI: 10.1007/s00115-021-01162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/21/2022]
Abstract
Eine COVID-19-Erkrankung kann zu schweren Krankheitsverläufen mit multiplen Organbeteiligungen und respiratorischen und neurologischen Funktionseinschränkungen führen. Schluckstörungen (Dysphagien) können in dieser Patientengruppe durch primäre Schädigungen des zentralen und peripheren neuronalen Netzwerkes der Schluckfunktion entstehen, aber auch bedingt durch die häufig längere intensivmedizinische Behandlung und Beatmung. Erste klinische Befunde zeigen persistierende Dysphagien im Rahmen des Post-COVID-Syndroms („Long-COVID“), sodass die Patienten auch längerfristige Maßnahmen zur Rehabilitation einer sicheren und suffizienten oralen Nahrungsaufnahme benötigen. Daher sollte in die Behandlung von COVID-19-Patienten ein strukturiertes erkrankungsspezifisches Monitoring in Bezug auf Dysphagiesymptome integriert werden, und atemtherapeutische Maßnahmen zur Regulation von Husteneffektivität und Atem-Schluck-Koordination sollten auch bei diesen Patienten essenzieller Bestandteil des Dysphagiemanagements sein. Herausforderungen ergeben sich dabei einerseits durch die erforderlichen Anpassungen etablierter Behandlungsstandards an den Infektionsschutz. Zudem müssen Auswahl und Durchführungsintensität therapeutischer Maßnahmen an die Kapazitäten und die spezifische Pathophysiologie der COVID-19- und Long-COVID-Patienten angepasst werden, um weitere funktionelle Verschlechterungen zu vermindern.
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Johnston M, Weldon M, Smart C, Shelton C, Eusuf A. A novel percutaneous tracheostomy technique to reduce aerosolisation during the COVID-19 pandemic: A description and case series. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021; 38:36-41. [PMID: 38620840 PMCID: PMC8041739 DOI: 10.1016/j.tacc.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 01/20/2023]
Abstract
Background COVID-19 is a global pandemic with many patients requiring prolonged mechanical ventilation. COVID-19 is associated with laryngeal oedema and a high rate of reintubation and difficult airway. Tracheostomy insertion is an aerosol generating procedure, so we strived to make our novel technique safe for operator and patient. Aim To share our experience of a novel percutaneous tracheostomy technique, based on a case series of 18 patients with COVID-19 pneumonitis. Method Our novel percutaneous tracheostomy technique is a landmark-based approach without bronchoscopic confirmation of the correct needle placement. Blunt dissection using tracheal dilators onto the tracheal rings facilitates first pass needle insertion into the trachea. The tracheal tube is retracted into the supraglottic airway, the cuff overinflated, and a wet throat pack inserted to reduce aerosolisation. Results From March 2020 to May 2020, 38 patients with suspected or confirmed COVID-19 presented to Royal Bolton Hospital requiring invasive ventilation. 18 patients underwent percutaneous tracheostomy. 6 patients have been decannulated, 12 patients died. Mean time from intubation to tracheostomy was 6.1 days and from tracheostomy to decannulation 20.6 days. No operator developed COVID-19 symptoms. Conclusions Despite the low numbers our novel technique appears to be safe, but confirmation requires a larger controlled trial. As an institution we have avoided difficulties with reintubation and reduced our drug usage.
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Affiliation(s)
| | | | - Chloe Smart
- Intensive Care Unit, Royal Bolton Hospital, Bolton, UK
| | - Clifford Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ajmal Eusuf
- Intensive Care Unit, Royal Bolton Hospital, Bolton, UK
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30
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Gupta A. COVID-19 and extracorporeal membrane oxygenation: experiences as a patient, general practitioner, wife and mother. Anaesth Rep 2021; 9:101-105. [PMID: 34027411 PMCID: PMC8131113 DOI: 10.1002/anr3.12120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 12/24/2022] Open
Abstract
I contracted SARS‐CoV‐2 early in the first wave of the COVID‐19 pandemic in the UK and, following nine days of mechanical ventilation, was one of the first few patients to be accepted for venovenous extracorporeal membrane oxygenation. I remained in hospital for 150 days, 34 of which I spent with full extracorporeal respiratory support. I have no recollection of my time on extracorporeal membrane oxygenation, but liberation from it was not the end of my story; I had to overcome numerous physical and mental challenges during recovery and rehabilitation. I hope my story is read by others who are recovering from COVID‐19 or critical illness more generally, and that it provides hope that the challenges of rehabilitation can be overcome. This reflection is a personal view of my illness as a patient. In it, I focus upon the aspects of my care that I can remember, predominantly around the time I became unwell but also during the recovery and rehabilitation period, which remains ongoing despite my discharge from hospital and subsequent return to work as a general practitioner.
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31
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Mills CS, Michou E, Hanratty A, Gibson A, Bellamy MC. The adaptation of the Leeds Post-Extubation Dysphagia Screen: Lessons learned during the COVID-19 pandemic. J Intensive Care Soc 2021; 23:281-284. [PMID: 36033238 PMCID: PMC9403521 DOI: 10.1177/1751143721998140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Post-extubation dysphagia (PED) can have serious consequences for critically unwell patients. COVID-19 has resulted in an increasing need for a PED screen in order to effectively identify patients and mitigate risk, whilst balancing under-resourced services. Online training provides the advantage of reducing time pressures on staff and supporting social distancing. This project aimed to adapt the Leeds Post-Extubation Dysphagia Screen (L-PEDS) and the associated training package to be more suitable and effective for use during COVID-19 pandemic. Methods The screen was modified to a digital format with additional guidance for users. The training package was shortened and converted to an online package while keeping the interactive mode of training. Results Preliminary results of 14 staff members indicate that the median confidence levels for screening patients for PED improved from 5 to 8 (on a scale of 0 to 10) after completing the L-PEDS-COVID training package. Likewise, knowledge of PED improved from a median of 4 to 8 (on a scale of 0 to 10). Training quality was rated at a median of 8 on a scale of 0 to 10 (0 being very poor; 10 being very good). Conclusions Preliminary evidence demonstrated increased knowledge of PED and confidence in screening. The development of an adapted version of the L-PEDS and online training package may allow easier implementation of post-extubation dysphagia screening. This could help to compensate for insufficient speech and language therapy critical care staffing, assist in identifying patients at risk and improve outcomes by enabling earlier and safe resumption of oral intake.
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Affiliation(s)
- Claire S Mills
- Speech & Language Therapy Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Emilia Michou
- Centre for Gastrointestinal Sciences, The University of Manchester, Manchester, UK
- Speech Language Therapy Department, University of Patras, Patras, Greece
| | - Andrea Hanratty
- Speech & Language Therapy Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Abby Gibson
- Speech & Language Therapy Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mark C Bellamy
- Adult Critical Care, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
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32
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Wallace S, McGrath BA. Laryngeal complications after tracheal intubation and tracheostomy. BJA Educ 2021; 21:250-257. [PMID: 34178381 DOI: 10.1016/j.bjae.2021.02.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- S Wallace
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - B A McGrath
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,University of Manchester Academic Critical Care, Wythenshawe Hospital, Manchester, UK
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Abstract
Background One of the main symptoms of severe infection with the new coronavirus‑2 (SARS-CoV-2) is hypoxemic respiratory failure because of viral pneumonia with the need for mechanical ventilation. Prolonged mechanical ventilation may require a tracheostomy, but the increased risk for contamination is a matter of considerable debate. Objective Evaluation of safety and effects of surgical tracheostomy on ventilation parameters and outcome in patients with COVID-19. Study design Retrospective observational study between March 27 and May 18, 2020, in a single-center coronavirus disease-designated ICU at a tertiary care German hospital. Patients Patients with COVID-19 were treated with open surgical tracheostomy due to severe hypoxemic respiratory failure requiring mechanical ventilation. Measurements Clinical and ventilation data were obtained from medical records in a retrospective manner. Results A total of 18 patients with confirmed SARS-CoV‑2 infection and surgical tracheostomy were analyzed. The age range was 42–87 years. All patients received open tracheostomy between 2–16 days after admission. Ventilation after tracheostomy was less invasive (reduction in PEAK and positive end-expiratory pressure [PEEP]) and lung compliance increased over time after tracheostomy. Also, sedative drugs could be reduced, and patients had a reduced need of norepinephrine to maintain hemodynamic stability. Six of 18 patients died. All surgical staff were equipped with N99-masks and facial shields or with powered air-purifying respirators (PAPR). Conclusion Our data suggest that open surgical tracheostomy can be performed without severe complications in patients with COVID-19. Tracheostomy may reduce invasiveness of mechanical ventilation and the need for sedative drugs and norepinehprine. Recommendations for personal protective equipment (PPE) for surgical staff should be followed when PPE is available to avoid contamination of the personnel.
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Bartier S, La Croix C, Evrard D, Hervochon R, Laccourreye O, Gasne C, Excoffier A, Tanaka L, Barry B, Coste A, Tankere F, Kania R, Nevoux J. Tracheostomies after SARS-CoV-2 intubation, performed by academic otorhinolaryngologists in the Paris area of France: Preliminary results. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:443-449. [PMID: 33707069 PMCID: PMC7931693 DOI: 10.1016/j.anorl.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective To analyse tracheostomies after intubation for SARS-Cov-2 infection performed by otorhinolaryngologists in 7 university hospitals in the Paris area of France during the month March 24 to April 23, 2020. Material and methods A multicentre retrospective observational study included 59 consecutive patients. The main goals were to evaluate the number, characteristics and practical conditions of tracheostomies, and the COVID-19 status of the otorhinolaryngologists. Secondary goals were to analyse tracheostomy time, decannulation rate, immediate postoperative complications and laryngotracheal axis status. Results Tracheostomy indications were for ventilatory weaning and extubation failure in 86% and 14% of cases, respectively. The technique was surgical, percutaneous or hybrid in 91.5%, 3.4% and 5.1% of cases, respectively. None of the operators developed symptoms consistent with COVID-19. Postoperative complications occurred in 15% of cases, with no significant difference between surgical and percutaneous/hybrid techniques (P = 0.33), although no complications occurred after percutaneous or hybrid tracheostomies. No procedures or complications resulted in death. The decannulation rate was 74.5% with a mean tracheostomy time of 20 ± 12 days. In 55% of the patients evaluated by flexible endoscopy after decannulation, a laryngeal abnormality was found. On univariate analysis, no clinical features had a significant influence on tracheostomy time, decannulation rate or occurrence of laryngeal lesions. Conclusion The main findings of the present retrospective study were: absence of contamination of the surgeons, heterogeneity of practices between centres, a high rate of complications and laryngeal lesions whatever the technique, and the specificities of the patients.
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Affiliation(s)
- S Bartier
- Service ORL, Centre hospitalier intercommunal de Créteil, Université Paris Est, 40, avenue de Verdun, 94000 Créteil, France.
| | - C La Croix
- Service ORL, AP-HP, Hôpital Cochin AP-HP, Université Paris centre, 27, rue du Faubourg-St.-Jacques, 75014 Paris, France
| | - D Evrard
- Service ORL, Hôpital Bichat, AP-HP, Université Paris centre, 46, rue Henri-Huchard, 75018 Paris, France
| | - R Hervochon
- Service ORL, AP-HP, Hôpital La Pitié-Salpétrière, Université Paris Sorbonne, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - O Laccourreye
- Service ORL, AP-HP, HEGP, Université Paris Centre, 20-40, rue Leblanc, 75015 Paris, France
| | - C Gasne
- Service ORL, AP-HP, Hôpital Tenon, AP-HP, Université Paris Sorbonne, 4, rue de la Chine, 75020 Paris, France
| | - A Excoffier
- Service ORL, AP-HP, Hôpital Tenon, AP-HP, Université Paris Sorbonne, 4, rue de la Chine, 75020 Paris, France
| | - L Tanaka
- Service ORL, AP-HP, Hôpital Bicêtre, Université Paris Saclay, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - B Barry
- Service ORL, Hôpital Bichat, AP-HP, Université Paris centre, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Coste
- Service ORL, Centre hospitalier intercommunal de Créteil, Université Paris Est, 40, avenue de Verdun, 94000 Créteil, France
| | - F Tankere
- Service ORL, AP-HP, Hôpital La Pitié-Salpétrière, Université Paris Sorbonne, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - R Kania
- Service ORL, AP-HP, Hôpital Lariboisière, Université Paris Nord, 2, rue Ambroise-Paré, 75010 Paris, France
| | - J Nevoux
- Service ORL, AP-HP, Hôpital Bicêtre, Université Paris Saclay, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
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35
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Nadiger M, Ness-Cochinwala M, Sanchez-Vegas C, Sendi P, Ho B, Totapally BR, Sachdeva R. Pediatric COVID-19 presenting as supraglottitis with vocal cord hypomobility. SAGE Open Med Case Rep 2021; 9:2050313X21989465. [PMID: 33633863 PMCID: PMC7887695 DOI: 10.1177/2050313x21989465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022] Open
Abstract
In the United States, an estimated 7.3% of confirmed cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19) are among persons aged less than 18 years. Data regarding clinical manifestations in this age group are still evolving. An upper airway predilection has been reported in children. We describe the case of a 15-year-old female with supraglottitis and unilateral hypomobility of vocal cord with concern for critical airway, associated with COVID-19. She was managed by a multidisciplinary team including critical care, infectious diseases, and otolaryngology. This report adds to the sparse but evolving body of literature on the clinical presentation of COVID-19 disease in children.
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Affiliation(s)
- Meghana Nadiger
- Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, FL, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Manette Ness-Cochinwala
- Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, FL, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Carolina Sanchez-Vegas
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.,Division of Infectious Disease, Nicklaus Children's Hospital, Miami, FL, USA
| | - Prithvi Sendi
- Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, FL, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Brian Ho
- Division of Otolaryngology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Balagangadhar R Totapally
- Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, FL, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Ramesh Sachdeva
- Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, FL, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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36
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Bertini P, Forfori F, Bruschini L, Corradi F, Ribechini A, Brogi E, Guarracino F. Percutaneous Tracheostomy in COVID-19 Critically Ill Patients: Experience from 30 Consecutive Procedures. Int Arch Otorhinolaryngol 2021; 25:e135-e140. [PMID: 33552294 PMCID: PMC7851370 DOI: 10.1055/s-0040-1718528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/08/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction Percutaneous tracheostomy (PT) in the intensive care unit (ICU) is a well-established practice that shows a reduced risk of wound infection compared with surgical tracheostomy, thus facilitating mechanical ventilation, nursing procedures, reduction in sedation and early mobilization. Objective This is an observational case-control study that compares the results of PT in ICU patients with coronavirus disease 2019 (COVID-19) prospectively enrolled to a similar group of subjects, retrospectively recruited, without COVID-19. Methods Ninety-eight consecutive COVID-19 patients admitted to the ICU at Pisa Azienda Ospedaliero Universitaria Pisana between March 11th and May 20 th , 2020 were prospectively studied. Thirty of them underwent PT using different techniques. Another 30 non-COVID-19 ICU patients were used as a control-group. The main outcome was to evaluate the safety and feasibility of PT in COVID-19 patients. We measured the rate of complications. Results Percutaneous tracheostomy was performed with different techniques in 30 of the 98 COVID-19 ICU patients admitted to the ICU. Tracheostomy was performed on day 10 (mean 10 ± 3.3) from the time of intubation. Major tracheal complications occurred in 5 patients during the procedure. In the control group of 30 ICU patients, no differences were found with regards to the timing of the tracheostomy, whereas a statistically significant difference was observed regarding complications with only one tracheal ring rupture reported. Conclusion Percutaneous tracheostomy in COVID-19 patients showed a higher rate of complications compared with controls even though the same precautions and the same expertise were applied. Larger studies are needed to understand whether the coronavirus disease itself carries an increased risk of tracheal damage.
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Affiliation(s)
- Pietro Bertini
- Cardiothoracic and Vascular Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Francesco Forfori
- Department of Anesthesia and Critical Care Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Università di Pisa, Pisa, Italy
| | - Luca Bruschini
- ENT Audiology and Phoniatric Unit, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, Università di Pisa, Pisa, Italy
| | - Francesco Corradi
- Department of Anesthesia and Critical Care Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Università di Pisa, Pisa, Italy
| | - Alessandro Ribechini
- Thoracic Endoscopy Unit, Cardiothoracic and vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Etrusca Brogi
- Department of Anesthesia and Critical Care Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Università di Pisa, Pisa, Italy
| | - Fabio Guarracino
- Cardiothoracic and Vascular Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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37
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Ginestra JC, Atkins J, Mikkelsen M, Mitchell OJ, Gutsche J, Jablonski J, Panchanadam V, Junker P, Schweickert W, Anesi G, Anderson B, Pierce M, Fuchs BD, Wani AA. The I-READI Quality and Safety Framework: A Health System’s Response to Airway Complications in Mechanically Ventilated Patients with Covid-19. ACTA ACUST UNITED AC 2021. [PMCID: PMC7743892 DOI: 10.1056/cat.20.0305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Health care institutions responding to quality and safety challenges during times of crisis, such as emerging infectious diseases or natural disasters, can follow the I-READI conceptual framework: Integration, Root Cause Analysis, Evidence Review, Adaptation, Dissemination, and Implementation. The University of Pennsylvania Health System developed this approach by drawing on lessons learned from rapidly coordinating changes to their ventilator management practices. They modified their practices to improve patient safety after recognizing high rates of airway complications among mechanically ventilated patients with Covid-19. Vertical and horizontal integration of their quality and safety teams helped streamline problem solving, enrich collaboration, and coordinate implementation. Root cause analysis and evidence review framed their practice adaptation, ensuring that they prioritized patient and health care worker safety. Daily safety huddles engaged frontline providers and promoted dissemination of the revised interventions. Telemedicine oversight and real-time ICU dashboards enabled system-wide implementation, goal setting, and continuous performance feedback. Under their revised guidelines, the rate of endotracheal tube obstruction among mechanically ventilated patients with Covid-19 decreased from 9.2% to less than 1%, and reintubation rates decreased from 36% to 9%.
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Affiliation(s)
- Jennifer Claire Ginestra
- Fellow, Pulmonary and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joshua Atkins
- Co-Chair, Penn Medicine Airway Safety Committee, Philadelphia, Pennsylvania, USA
- Associate Professor, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark Mikkelsen
- Chief, Section of Medical Critical Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Director, Medical Intensive Care Unit, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
- Associate Professor, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Oscar J.L. Mitchell
- Fellow, Pulmonary and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacob Gutsche
- Chief of Cardiac Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Associate Chief Medical Officer for Critical Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Associate Professor, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Juliane Jablonski
- Critical Care RN Systems Strategist, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Venkat Panchanadam
- Data Scientist, Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Paul Junker
- Director of Analytics, Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - William Schweickert
- Director of Medical Critical Care Operations, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Vice Chair for Quality and Safety, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Associate Professor of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - George Anesi
- Director, Medical Critical Care Bioresponse Team, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian Anderson
- Associate Medical Director, Medical Intensive Care Unit, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Assistant Professor of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Margarete Pierce
- Director, Respiratory Care and Pulmonary Diagnostics, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Barry David Fuchs
- Medical Director, Medical Intensive Care Unit and Respiratory Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Medical Director, Medical Critical Care and Respiratory Care Services, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Professor of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arshad A. Wani
- Director, Respiratory Care Services, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Associate Professor of Clinical Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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38
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Ajeigbe T, Ria B, Wates E, Mattine S. Severe parapharyngeal abscess that developed significant complications: management during the COVID-19 pandemic. BMJ Case Rep 2020; 13:e236449. [PMID: 33370968 PMCID: PMC10577725 DOI: 10.1136/bcr-2020-236449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 11/15/2022] Open
Abstract
A 50-year-old Caucasian man presented to the emergency department during the early stages of the COVID-19 pandemic with a rapidly progressive facial swelling, fever, malaise and myalgia. The patient had recently travelled to a COVID-19-prevalent European country and was therefore treated as COVID-19 suspect. The day before, the patient sustained a burn to his left forearm after falling unconscious next to a radiator. A CT neck and thorax showed a parapharyngeal abscess, which was surgically drained, and the patient was discharged following an intensive care admission. He then developed mediastinitis 3 weeks post-discharge which required readmission and transfer to a cardiothoracic unit for surgical drainage. This report discusses the evolution of a deep neck space infection into a mediastinitis, a rare and life-threatening complication, despite early surgical drainage. This report also highlights the difficulties faced with managing patients during the COVID-19 pandemic.
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Affiliation(s)
- Teslimat Ajeigbe
- Oral and Maxillofacial Unit, Worcestershire Royal Hospital, Worcester, Worcestershire, UK
| | - Basmal Ria
- Department of Oral Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Emma Wates
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Samuel Mattine
- Oral and Maxillofacial Unit, Worcestershire Royal Hospital, Worcester, Worcestershire, UK
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39
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Starkov YG, Lukich KV, Dzhantukhanova SV, Plotnikov GP, Zamolodchikov RD, Zvereva AA. [Endoscopy-assisted dilatational tracheostomy in patients with COVID-19]. Khirurgiia (Mosk) 2020:16-21. [PMID: 33301248 DOI: 10.17116/hirurgia202012116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To summarize an experience of endoscopy-assisted dilatational tracheostomies in patients with COVID-19. MATERIAL AND METHODS There were 31 endoscopy-assisted dilatational tracheostomies in patients with COVID-19 for the period from April 17 to June 10, 2020 (11 women and 19 men). Mean age of patients was 66.7 years (range 48-87). Tracheostomy was performed using Ciaglia (22) and Griggs (9) techniques. All procedures were carried out at the intensive care unit in elective fashion. RESULTS Tracheostomy was performed in 19.8% of ICU patients or 36.9% of all patients on mechanical ventilation within 6.5±2.5 days [min 3, max 11]. There were 22 survivors with tracheostomy (70.9%) that is comparable with survival of patients without mechanical ventilation (79.7%) and slightly higher than in patients on ventilation without tracheostomy (65.4%). No complications during the procedure were noted. CONCLUSION Endoscopy-assisted dilatational tracheostomy is preferred for prolonged mechanical ventilation, including patients with COVID-19. The undeniable advantages of this operation are fewer intraoperative complications due to endoscopic control, and lower risk of tracheal strictures.
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Affiliation(s)
- Yu G Starkov
- Vishnevsky National Medical Research Center for Surgery, Moscow, Russia
| | - K V Lukich
- Vishnevsky National Medical Research Center for Surgery, Moscow, Russia
| | | | - G P Plotnikov
- Vishnevsky National Medical Research Center for Surgery, Moscow, Russia
| | - R D Zamolodchikov
- Vishnevsky National Medical Research Center for Surgery, Moscow, Russia
| | - A A Zvereva
- Vishnevsky National Medical Research Center for Surgery, Moscow, Russia
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40
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Gandhi A, Sokhi J, Lockie C, Ward PA. Emergency Tracheal Intubation in Patients with COVID-19: Experience from a UK Centre. Anesthesiol Res Pract 2020; 2020:8816729. [PMID: 33376486 PMCID: PMC7729388 DOI: 10.1155/2020/8816729] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/06/2020] [Accepted: 11/23/2020] [Indexed: 12/15/2022] Open
Abstract
This retrospective observational case series describes a single centre's preparations and experience of 53 emergency tracheal intubations in patients with COVID-19 respiratory failure. The findings of a contemporaneous online survey exploring technical and nontechnical aspects of airway management, completed by intubation team members, are also presented. Preparations included developing a COVID-19 intubation standard operating procedure and checklist, dedicated airway trolleys, a consultant-led mobile intubation team, and an airway education programme. Tracheal intubation was successful in all patients. Intubation first-pass success rate was 85%, first-line videolaryngoscopy use 79%, oxygen desaturation 49%, and hypotension 21%. Performance was consistent across all clinical areas. The main factor impeding first-pass success was larger diameter tracheal tubes. The majority of intubations was performed by consultant anaesthetists. Nonconsultant intubations demonstrated higher oxygen desaturation rates (75% vs. 45%, p=0.610) and lower first-pass success (0% vs. 92%, p < 0.001). Survey respondents (n = 29) reported increased anxiety at the start of the pandemic, with statistically significant reduction as the pandemic progressed (median: 4/5 very high vs. 2/5 low anxiety, p < 0.001). Reported procedural/environmental challenges included performing tasks in personal protective equipment (62%), remote-site working (48%), and modification of normal practices (41%)-specifically, the use of larger diameter tracheal tubes (21%). Hypoxaemia was identified by 90% of respondents as the most challenging patient-related factor during intubations. Our findings demonstrate that a consultant-led mobile intubation team can safely perform tracheal intubation in critically ill COVID-19 patients across all clinical areas, aided by thorough preparation and training, despite heightened anxiety levels.
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Affiliation(s)
- Ajay Gandhi
- Chelsea and Westminster Hospital, London, UK
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41
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Batarseh E, Kersten BP, Pinelo AC, Nadler JN, Schwartz SA. Angioedema in African American Patients Hospitalized for COVID-19. Am J Respir Crit Care Med 2020; 202:1581-1584. [PMID: 33052705 PMCID: PMC7706147 DOI: 10.1164/rccm.202006-2223le] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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42
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Sherren PB, Ostermann M, Agarwal S, Meadows CIS, Ioannou N, Camporota L. COVID-19-related organ dysfunction and management strategies on the intensive care unit: a narrative review. Br J Anaesth 2020; 125:912-925. [PMID: 32988604 PMCID: PMC7833857 DOI: 10.1016/j.bja.2020.08.050] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/17/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has resulted in a significant surge of critically ill patients and an unprecedented demand on intensive care services. The rapidly evolving understanding of pathogenesis, limited disease specific evidence, and demand-resource imbalances have posed significant challenges for intensive care clinicians. COVID-19 is a complex multisystem inflammatory vasculopathy with a significant mortality implication for those admitted to intensive care. Institutional strategic preparation and meticulous intensive care support are essential to maximising outcomes during the pandemic. The significant mortality variation observed between institutions and internationally, despite a single aetiology and uniform presentation, highlights the potential influence of management strategies on outcome. Given that optimal organ support and adjunctive therapies for COVID-19 have not yet been well defined by trial-based outcomes, strategies are predicated on existing literature and experiential learning. This review outlines the relevant pathophysiology and management strategies for critically ill patients with COVID-19, and shares some of the collective learning accumulated in a high volume severe respiratory failure centre in London.
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Affiliation(s)
| | | | - Sangita Agarwal
- Department of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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43
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Vergara J, Skoretz SA, Brodsky MB, Miles A, Langmore SE, Wallace S, Seedat J, Starmer HM, Bolton L, Clavé P, Freitas SV, Bogaardt H, Matsuo K, de Souza CM, Mourão LF. Assessment, Diagnosis, and Treatment of Dysphagia in Patients Infected With SARS-CoV-2: A Review of the Literature and International Guidelines. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:2242-2253. [PMID: 32960646 DOI: 10.1044/2020_ajslp-20-00163] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Speech-language pathologists are playing a crucial role in the assessment and management of patients infected with severe acute respiratory syndrome coronavirus 2. Our goal was to synthesize peer-reviewed literature and association guidelines from around the world regarding dysphagia assessment and management for this specific population. Method A review of publications available in the PubMed database and official guidelines of international groups was performed on May 23, 2020. The information was synthesized and categorized into three content areas for swallowing: clinical evaluation, instrumental assessment, and rehabilitation. Results Five publications were identified in the PubMed database. Following title, abstract, and full-text review, only three publications met inclusion criteria: two reviews and one narrative report. Additionally, 19 international guidelines were reviewed. To assess swallowing, a modified clinical evaluation was recommended and only following a risk assessment. Instrumental assessments were often considered aerosol generating, especially transnasal procedures such as endoscopy and manometry. For this reason, many associations recommended that these examinations be performed only when essential and with appropriate personal protective equipment. Guidelines recommended that intervention should focus on compensatory strategies, including bolus modification, maneuvers/postural changes, and therapeutic exercises that can be conducted with physical distancing. Respiratory training devices were not recommended during rehabilitation. Conclusions International associations have provided extensive guidance regarding the level of risk related to the management of dysphagia in this population. To date, there are no scientific papers offering disease and/or recovery profiling for patients with dysphagia and coronavirus disease 2019. As a result, research in this area is urgently needed.
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Affiliation(s)
- José Vergara
- Department of Surgery, University of Campinas, Campinas, São Paulo, Brazil
| | - Stacey A Skoretz
- School of Audiology & Speech Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Martin B Brodsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Anna Miles
- Speech Science, University of Auckland, New Zealand
| | - Susan E Langmore
- Department of Otolaryngology-Head & Neck Surgery, School of Medicine, Boston University, MA
| | - Sarah Wallace
- Department of Speech, Voice and Swallowing, Wythenshawe Hospital, Manchester University NHS Foundation Trust, United Kingdom
- National Tracheostomy Safety Project, Manchester, United Kingdom
| | - Jaishika Seedat
- Department of Speech and Hearing Therapy, University of Witwatersrand, Johannesburg, South Africa
| | - Heather M Starmer
- Division of Head and Neck Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University, Palo Alto, CA
| | - Lee Bolton
- Speech and Language Therapy Service, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (Ciberehd), Hospital de Mataró, Autonomous University of Barcelona, Spain
| | - Susana Vaz Freitas
- Faculty of Health Sciences, Speech Therapy Department, University Fernando Pessoa, Porto, Portugal
- Centro Hospitalar Universitário do Porto, ENT Department, Portugal
- Laboratório de Inteligência Artificial e Análise de Dados, LIAAD-INESCTEC, Porto, Portugal
| | - Hans Bogaardt
- Faculty of Medicine and Health, The University of Sydney, New South Wales Australia
| | - Koichiro Matsuo
- Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
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Harper S, Robinson M, Manning G, Jones A, Hobson J, Shelton CL. Management of tracheostomy-related tracheomegaly in a patient with COVID-19 pneumonitis. Anaesth Rep 2020; 8:e12076. [PMID: 33210094 DOI: 10.1002/anr3.12076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2020] [Indexed: 11/06/2022] Open
Abstract
Acquired tracheomegaly is a rare condition associated with pulmonary fibrosis, connective tissue disease and the use of cuffed tracheal tubes. We describe the urgent tracheal re-intubation and subsequent tracheal repair of a previously well 58-year-old man who developed tracheostomy-related tracheomegaly during prolonged mechanical ventilation for coronavirus disease 2019 pneumonitis. Urgent tracheal re-intubation was required due to a persistent cuff leak, pneumomediastinum and malposition of the tracheostomy tube. We describe the additional challenges and risks associated with airway management in patients with tracheomegaly, and discuss how even in urgent cases these can be mitigated through planning and teamwork. We present a stepwise approach to tracheal re-intubation past a large tracheal dilatation, including the use of an Aintree catheter inserted via the existing tracheal stoma for oxygenation or tracheal re-intubation if required. Computed tomography imaging was valuable in characterising the defect and developing a safe airway management strategy before starting the procedure. This report emphasises the role of planning, teamwork and the development of an appropriate airway strategy in the safe management of complex cases.
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Affiliation(s)
- S Harper
- North West School of Anaesthetics Health Education England North West Manchester UK
| | - M Robinson
- North West School of Anaesthetics Health Education England North West Manchester UK
| | - G Manning
- Department of Anaesthesia Wythenshawe Hospital Manchester University NHS Foundation Trust Manchester UK
| | - A Jones
- Department of Anaesthesia Wythenshawe Hospital Manchester University NHS Foundation Trust Manchester UK
| | - J Hobson
- Division of Surgery Wythenshawe Hospital Manchester University NHS Foundation Trust Manchester UK
| | - C L Shelton
- Department of Anaesthesia Wythenshawe Hospital Manchester University NHS Foundation Trust Manchester UK.,Lancaster Medical School Faculty of Health and Medicine Lancaster University Lancaster UK
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45
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Vergara J, Starmer HM, Wallace S, Bolton L, Seedat J, de Souza CM, Freitas SV, Skoretz SA. Swallowing and Communication Management of Tracheostomy and Laryngectomy in the Context of COVID-19: A Review. JAMA Otolaryngol Head Neck Surg 2020; 147:2771746. [PMID: 33057590 DOI: 10.1001/jamaoto.2020.3720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE The care of patients with a surgically modified airway, such as tracheostomy or laryngectomy, represents a challenge for speech-language pathologists (SLPs) in the context of the coronavirus disease 2019 (COVID-19) pandemic. The objective was to review available publications and practice guidelines on management of tracheostomy and laryngectomy in the context of COVID-19. This study performed a review and synthesis of information available in the PubMed database and from national SLP organizations across 6 countries. OBSERVATIONS From the search, 22 publications on tracheostomy and 3 referring to laryngectomy were identified. After analysis of titles and abstracts followed by full-text review, 4 publications were identified as presenting guidelines for specific approaches to tracheostomy and were selected; all 3 publications on laryngectomy were selected. The main guidelines on tracheostomy described considerations during management (eg, cuff manipulation, suctioning, valve placement) owing to the increased risk of aerosol generation and transmission during swallowing and communication interventions in this population. Regarding laryngectomy, the guidelines focused on the care and protection of both the professional and the patient, offering recommendations on the management of adverse events and leakage of the tracheoesophageal prosthesis. CONCLUSIONS AND RELEVANCE Frequent guideline updates for SLPs are necessary to inform best practice and ensure patient and health care worker protection and safety while providing high-quality care and rehabilitation.
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Affiliation(s)
- José Vergara
- Department of Surgery, University of Campinas, Campinas, São Paulo, Brazil
| | - Heather M Starmer
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, California
| | - Sarah Wallace
- Department of Speech, Voice and Swallowing, Manchester University NHS Foundation Trust, Manchester, England
| | - Lee Bolton
- Speech and Language Therapy Service, Imperial College Healthcare NHS Trust, London, England
| | - Jaishika Seedat
- Department of Speech and Hearing Therapy, University of Witwatersrand, Johannesburg, South Africa
| | | | - Susana Vaz Freitas
- Faculty of Health Sciences, Speech Therapy Department, University Fernando Pessoa, Porto, Portugal
- ENT Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Laboratório de Inteligência Artificial e Análise de Dados, LIAAD-INESCTEC, Porto, Portugal
| | - Stacey A Skoretz
- School of Audiology and Speech Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
- Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, British Columbia, Canada
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46
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A Systematic Review on Tracheostomy in COVID-19 Patients: Current Guidelines and Safety Measures. Indian J Otolaryngol Head Neck Surg 2020; 74:2738-2742. [PMID: 33014752 PMCID: PMC7521770 DOI: 10.1007/s12070-020-02152-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023] Open
Abstract
At this moment the world is fighting with COVID-19 pandemic. Because of increasing number of critical cases, the ICU admissions are also increasing and overwhelming the hospital. These group of patients often required Tracheostomy for proper management and ventilation. As Surgeons we often required to examine and perform procedures in head and neck patients and are in high risk of exposure to aerosol and droplet contamination. We did a literature search for research regarding tracheostomy and its post procedure care during the ongoing COVID-19 pandemic. In this review various international guidelines and sources were put together, and we aim to summarize in a systematic way the available recommendations: indications, timing, technique and safety measures for tracheostomy for COVID-19 patients, from all over the world.
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47
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Moran JV, Godil SA, Goldner B, Godil K, Aslam J. Post-Extubation Stridor Complicating COVID-19-Associated Acute Respiratory Distress Syndrome: A Case Series. Cureus 2020; 12:e10492. [PMID: 33083191 PMCID: PMC7567298 DOI: 10.7759/cureus.10492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Post-extubation stridor is a known complication of mechanical ventilation that affects a substantial number of all critical care patients and leads to increased morbidity and mortality. Common risk factors for the development of post-extubation stridor include female gender, older age, and prolonged length of mechanical ventilation. There may be an increased incidence of post-extubation stridor in patients who require mechanical ventilation to manage the respiratory complications of COVID-19. In this case series, we analyzed nine patients from across our institution who were intubated to manage acute respiratory distress syndrome (ARDS) secondary to COVID-19 and subsequently developed post-extubation stridor. The patients were predominantly females with prolonged intubations and multiple days of prone ventilation. While the patients in this case series possessed some of the well-described risk factors for post-extubation stridor, there may be risk factors specific to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that make these patients more susceptible to the complication. The cuff leak test was performed on the majority of patients in the case series and did not successfully predict successful extubation in this population. Our analysis suggests that prophylactic corticosteroids given in the 24-48 hours prior to elective extubation in female COVID-19 patients who were intubated for more than six days with consecutive days of intermittent prone ventilation may be helpful in reducing the incidence of post-extubation stridor in this population. Overall, this case series elucidates the need for exceptionally close monitoring of COVID-19 patients upon extubation for the development of stridor.
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Affiliation(s)
- Joseph V Moran
- Internal Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Sara A Godil
- Internal Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Breanna Goldner
- Internal Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Kareem Godil
- Internal Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Jonaid Aslam
- Pulmonary and Critical Care Medicine, Lehigh Valley Health Network, Allentown, USA
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Venn AMR, Schmidt JM, Mullan PC. Pediatric croup with COVID-19. Am J Emerg Med 2020; 43:287.e1-287.e3. [PMID: 32980228 PMCID: PMC7490245 DOI: 10.1016/j.ajem.2020.09.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
We describe three previously healthy children, admitted from our emergency department (ED) to our free-standing children's hospital, as the first documented cases of croup as a manifestation of SARS-CoV-2 infection. All three cases (ages 11 months, 2 years, and 9 years old) presented with non-specific upper-respiratory-tract symptoms that developed into a barky cough with associated stridor at rest and respiratory distress. All were diagnosed with SARS-CoV-2 by polymerase chain reaction testing from nasopharyngeal samples that were negative for all other pathogens including the most common etiologies for croup. Each received multiple (≥3) doses of nebulized racemic epinephrine with minimal to no improvement shortly after medication. All had a prolonged period of time from ED presentation until the resolution of their stridor at rest (13, 19, and 21 h). All received dexamethasone early in their ED treatment and all were admitted. All three received at least one additional dose of dexamethasone, an atypical treatment occurrence in our hospital, due to each patient's prolonged duration of symptoms. One child required heliox therapy and admission to intensive care. All patients were eventually discharged. Pathogen testing is usually not indicated in croup, but with "COVID-19 croup," SARS-CoV-2 testing should be considered given the prognostic significance and prolonged quarantine implications. Our limited experience with this newly described COVID-19 croup condition suggests that cases can present with significant pathology and might not improve as rapidly as those with typical croup.
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Affiliation(s)
- April M R Venn
- Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA 23501-1980, USA; Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Hospital, 630 W. 168th St, New York, NY 10032, USA.
| | - James M Schmidt
- Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA 23501-1980, USA.
| | - Paul C Mullan
- Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA, 23507, USA; Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA 23501-1980, USA.
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McGrath BA, Brenner MJ, Warrillow SJ. Tracheostomy for COVID-19: business as usual? Br J Anaesth 2020; 125:867-871. [PMID: 32951840 PMCID: PMC7470741 DOI: 10.1016/j.bja.2020.08.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Brendan A McGrath
- Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Michael J Brenner
- Department of Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
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50
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Bindra A, Kajal S, Sikka K. Tracheostomy during COVID-19 Pandemic: Viewpoint. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2020. [DOI: 10.1055/s-0040-1716428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Ashish Bindra
- Department of Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Smile Kajal
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, New Delhi, India
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