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de Almeida TM, Fernandes RG, Binhardi VDR, França JID, Magnoni D, da Silva RG. Factors associated with oropharyngeal dysphagia in individuals with cardiovascular disease and COVID-19. Codas 2024; 36:e20220112. [PMID: 39166598 PMCID: PMC11340871 DOI: 10.1590/2317-1782/20242022112en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 03/12/2024] [Indexed: 08/23/2024] Open
Abstract
PURPOSE Oropharyngeal dysphagia (OD) is one of the possible outcomes in patients hospitalized with COVID-19 and also in the population hospitalized for the treatment of cardiovascular disease. Thus, knowing the predictive risk factors for OD may help with referral and early intervention. This study aimed to verify the association of different factors with OD in hospitalized individuals with cardiovascular disease and COVID-19. METHODS Cross-sectional clinical study approved by the Research Ethics Committee (4,521,771). Clinical evaluation of swallowing was carried out in 72 adult patients with cardiovascular disease and COVID-19 hospitalized from April to September 2020. Individuals under 18 years of age and without previous cardiovascular disease were excluded. The presence of general clinical and/or neurological complications, pronation, stay in the intensive care unit (ICU), orotracheal intubation (OTI), tracheostomy tube, oxygen support and age were considered as predictive risk factors for oropharyngeal dysphagia. Fisher's exact test, Mann Whitney test and logistic regression model were used for analysis. RESULTS General clinical complications (p=0.001), pronation (p=0.003), ICU stay (p=0.043), in addition to the need for oxygen supplementation (p=0.023) and age (p= 0 .037) were statistically significant factors associated. The pronation (0.013) and age (0.038) were independently associated with dysphagia. OTI (p=0.208), tracheostomy (p=0.707) and the presence of previous cerebrovascular accidents (p=0.493) were not statistically significant. CONCLUSION In this study, age and prone position were factors independently associated with oropharyngeal dysphagia, complications such as the need for oxygen supplementation, in addition to the need for ICU admission, were also associated factors in the population.
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Affiliation(s)
| | | | | | | | - Daniel Magnoni
- Instituto Dante Pazzanese de Cardiologia - São Paulo (SP), Brasil.
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Pulia MS, Herrin R, Robison RD, Gustafson S, Broghammer C, Grant R, Schwei RJ, Rogus-Pulia N. Dysphagia Is an Underrecognized Risk Factor for Viral Pneumonia Severity. Dysphagia 2024:10.1007/s00455-024-10697-z. [PMID: 38676776 DOI: 10.1007/s00455-024-10697-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/12/2024] [Indexed: 04/29/2024]
Abstract
The aim of this study was to examine the role of pre-existing dysphagia as a risk factor for COVID-19 severity among adults ≥50 years of age presenting to the emergency department (ED). This was a retrospective cohort study that used electronic health record data from two Midwestern EDs in the same health care system. The sample included patients ≥50 years of age who tested positive for SARS-COV-2 during an ED visit between March 15, 2020 and November 19, 2020. Patients were dichotomized based on documented history of dysphagia. The primary outcome was the highest World Health Organization COVID-19 clinical severity score within 30-days of ED arrival. Patients with a score of <4 were classified as non-severe whereas a score ≥4 was considered severe. Chi-square tests were used to assess differences in clinical severity scores between patients with and without dysphagia. A logistic regression model was created to estimate the odds of a severe COVID-19 clinical score. The sample included 126 patients without dysphagia and 40 patients with dysphagia. Patients with a history of dysphagia were more likely to develop severe COVID-19 disease compared to patients without (65.0% vs. 41.3%, p = 0.015). In multivariable analysis, patients with preexisting dysphagia (OR 2.38, 95% CI: 1.05-5.42; p = 0.038) and diabetes (OR 2.42 95% CI: 1.15-5.30; p = 0.021) had significantly increased odds of developing severe COVID-19. This study showed that a pre-existing diagnosis of dysphagia was independently associated with COVID-19 severity in adults ≥50 years of age.
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Affiliation(s)
- Michael S Pulia
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin Madison School of Medicine and Public Health, 800 University Bay Drive Suite 310, Madison, WI, 53705, USA.
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin Madison, 1513 University Ave., Madison, WI, USA.
| | - Rachelle Herrin
- University of Wisconsin Madison School of Medicine and Public Health, 750 Highland Ave., Madison, WI, USA
| | - Raele Donetha Robison
- Department of Medicine, University of Wisconsin Madison School of Medicine and Public Health, 750 Highland Ave.,, Madison, WI, USA
- Center for Health Disparities Research , University of Wisconsin Madison, 600 Highland Ave, MSC 3690, K$, Madison, WI, 53792, USA
| | - Sara Gustafson
- Department of Medicine, University of Wisconsin Madison School of Medicine and Public Health, 750 Highland Ave.,, Madison, WI, USA
| | - Charles Broghammer
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin Madison School of Medicine and Public Health, 800 University Bay Drive Suite 310, Madison, WI, 53705, USA
| | - Rosemary Grant
- University of Wisconsin Madison School of Medicine and Public Health, 750 Highland Ave., Madison, WI, USA
| | - Rebecca J Schwei
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin Madison School of Medicine and Public Health, 800 University Bay Drive Suite 310, Madison, WI, 53705, USA
| | - Nicole Rogus-Pulia
- Department of Medicine, University of Wisconsin Madison School of Medicine and Public Health, 750 Highland Ave.,, Madison, WI, USA
- Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, USA
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Guillen-Sola A, Ramírez C, Nieto S, Duarte E, Tejero M, Grillo C, Bel H, Boza R. Therapeutic approach to dysphagia in post-COVID patients in a rehabilitation unit: a descriptive longitudinal study. Eur J Phys Rehabil Med 2024; 60:373-381. [PMID: 38502558 PMCID: PMC11112509 DOI: 10.23736/s1973-9087.24.08234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND A high rate of hospitalized patients for COVID-19 had dysphagia, frequently underdiagnosed, and not treated, inducing a prolonged dysphagia with protracted recovery. Specific treatments and protocols have not been well described yet. AIM Given the potential benefits of respiratory muscle training (IEMT) and neuromuscular stimulation (NMES) in dysphagia treatment, this study aimed to assess the feasibility of the protocol used for treating dysphagia in patients who experienced prolonged hospitalization for COVID-19. DESIGN Observational, descriptive, prospective study. SETTING Department of Physical Medicine and Rehabilitation of a tertiary University hospital. POPULATION Fifty-eight COVID-19 patients were admitted for intensive rehabilitation (March 2020 to October 2021) were prospectively studied. METHODS Dysphagia was diagnosed using videofluoroscopy and treated with a 3-week protocol adapted from neuromuscular stimulation (NMES) in a motor threshold and inspiratory/expiratory muscle strength training (IEMST), five sets of five repetitions three times daily for 3 weeks. Feasibility was assessed with adherence, outcomes achieved, and occurrence of adverse/unexpected events. Respiratory function (peak cough flow, maximal inspiratory/expiratory pressures) and swallow function (Penetration-Aspiration Scale and Bolus Residue Scale measured by videofluoroscopy) were recorded descriptive statistics, Student's t test for numerical data, and Wilcoxon Test for ordinal variables were applied. SPPSS vs28 and STATA version 15.1 (StataCorp, College Station, TX, USA) were used for statistical analysis. P values 0.05 were considered significant. RESULTS Dysphagia was highly prevalent in severe COVID-19 patients (86.6%); all respiratory and swallow parameters improved after a 3-week intervention and 12 of 18 patients dependent on tube feeding resumed a normal diet (66.7%; McNemar P=0.03), and 84.09% attended a no restriction diet at discharge. Adherence to treatment was 85%. No significant adverse events were detected. CONCLUSIONS We conclude that a structured swallowing-exercise training intervention based on IEMT and NMES is feasible and safe in prolonged hospitalization post-COVID patients. CLINICAL REHABILITATION IMPACT To describe rehabilitation protocols used to treat dysphagia in post-COVID patients will help us to optimize the available techniques in each center and to induce a faster recovery avoiding potential complications.
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Affiliation(s)
- Anna Guillen-Sola
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain -
- Rehabilitation Research Group, Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain -
| | - Cindry Ramírez
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Sonia Nieto
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
| | - Esther Duarte
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Marta Tejero
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
| | - Christian Grillo
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
| | - Helena Bel
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
| | - Roser Boza
- Department of Physical Medicine and Rehabilitation, Parc de Salut Mar, Barcelona, Spain
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Martín-Martínez A, Viñas P, Carrillo I, Martos J, Clavé P, Ortega O. The Impact of Frailty, Oropharyngeal Dysphagia and Malnutrition on Mortality in Older Patients Hospitalized for Covid-19. Aging Dis 2024; 15:927-938. [PMID: 37548930 PMCID: PMC10917529 DOI: 10.14336/ad.2023.0425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/25/2023] [Indexed: 08/08/2023] Open
Abstract
COVID-19 hospital mortality is higher among older patients through as yet little-known factors. We aimed to assess the effect of frailty (FR), oropharyngeal dysphagia (OD) and malnutrition (MN) on mortality in hospitalized COVID-19 older patients. Prospective cohort study of older patients (>70 years) with COVID-19 admitted to a general hospital from April 2020 to January 2021. Patients were evaluated on admission, discharge and at 1- and 3-months follow up. FR was assessed with FRAIL-VIG, OD with Volume-Viscosity Swallowing Test and MN with GLIM criteria. Clinical characteristics and outcomes, including intra-hospital, 1- and 3-month mortality, were analyzed. 258 patients were included (82.5±7.6 years; 58.9% women); 66.7% had FR (mild 28.7%, moderate 27.1% and severe 10.9%); 65.4%, OD and 50.6%, MN. OD prevalence increased from non-FR patients through the severity levels of FR: mild, moderate and severe (29.8%, 71.6%, 90.0%, 96.2%; p<0.0001, respectively), but not that of MN (50.6%, 47.1%, 52.5%, 56.0%). Mortality over the whole study significantly increased across FR categories (9.3% non-FR; 23.0% mild; 35.7% moderate; 75.0% severe; p<.001). Functionality (Barthel pre-admission, HR=0.983, CI-95%:0.973-0.993; p=0.001), OD (HR=2.953, CI-95%:0.970-8.989; p=0.057) and MN (HR=4.279, CI-95%:1.658-11.049; p=0.003) were independent risk factors for intra-hospital mortality. FR, OD and MN are highly prevalent conditions in older patients hospitalized with COVID-19. Functionality, OD and MN were independent risk factors for intra-hospital mortality.
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Affiliation(s)
- Alberto Martín-Martínez
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.
| | - Paula Viñas
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
| | - Irene Carrillo
- Department of Geriatrics, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain.
| | - Josep Martos
- Department of Geriatrics, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain.
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory CIBERehd CSdM-UAB, Hospital de Mataró, Consorci Sanitari del Maresme, Universitat Autònoma de Barcelona, 08304 Mataró, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain.
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Canta R, Vestito L, Castellini P, Trompetto C, Mori L, De Giovanni A, Puce L, Marinelli L. Successful Treatment of Post COVID-19 Neurogenic Dysphagia with Botulinum Toxin. Eur J Case Rep Intern Med 2023; 10:004105. [PMID: 38077706 PMCID: PMC10705822 DOI: 10.12890/2023_004105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Dysphagia in post COVID-19 patients could be caused by several factors, including reduced pharyngolaryngeal coordination due to SARS-CoV-2 tropism to the central and/or peripheral nervous system. To our knowledge, this is the first reported case of COVID-19-related dysphagia successfully treated with botulinum toxin type A injection. CASE DESCRIPTION We report the case of a patient with severe oropharyngeal dysphagia due to COVID-19 confirmed by fibre endoscopy. As a result, the patient required an enteral feeding tube. After two months of traditional swallowing therapies, there was only limited improvement. An electrophysiologic evaluation of the cricopharyngeal muscle was performed and showed a normal inhibition of the cricopharyngeal muscle, followed by a hypertonic rebound. Based on this result, we decided to perform a unilateral laryngeal injection of botulinum toxin type A. After the injection, the patient's swallowing function improved significantly, allowing him to return to oral feeding. DISCUSSION Newly diagnosed oropharyngeal dysphagia was found in 35.3% of hospitalised patients with COVID-19. There are several possible causes of COVID-19-associated dysphagia, including stroke, encephalitis, critical illness neuropathy, Guillain-Barré syndrome and skeletal muscle injury. In our case, since stroke was excluded by brain MRI, cranial nerve injury was a possible explanation for the difficult recovery of swallowing despite daily swallowing therapy. CONCLUSION We suggest that electrophysiology is a valid tool for the diagnosis and follow-up of patients with oropharyngeal dysphagia. LEARNING POINTS SARS-CoV-2 tropism to the central and/or peripheral nervous system can cause dysphagia in post COVID-19 patients.An electrophysiologic approach is useful for the diagnosis and follow-up of patients with oropharyngeal dysphagia.A single botulinum toxin type A injection is a valid treatment option to improve the swallowing function in patients with post COVID-19 dysphagia.
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Affiliation(s)
- Riccardo Canta
- Department of Neuroscience (DINOGMI), University of Genova, Genova,
Italy
- Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
| | - Lucilla Vestito
- Department of Neuroscience (DINOGMI), University of Genova, Genova,
Italy
- Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
| | - Paola Castellini
- IRCCS Ospedale Policlinico San Martino, Genova,
Italy
- SSD Foniatria, Genova,
Italy
| | - Carlo Trompetto
- Department of Neuroscience (DINOGMI), University of Genova, Genova,
Italy
- Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
| | - Laura Mori
- Department of Neuroscience (DINOGMI), University of Genova, Genova,
Italy
- Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
| | - Anna De Giovanni
- Department of Neuroscience (DINOGMI), University of Genova, Genova,
Italy
- Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
| | - Luca Puce
- Department of Neuroscience (DINOGMI), University of Genova, Genova,
Italy
- Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
| | - Lucio Marinelli
- Department of Neuroscience (DINOGMI), University of Genova, Genova,
Italy
- Division of Neuro-rehabilitation, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
- Division of Clinical Neurophysiology, IRCCS Ospedale Policlinico San Martino, Genova,
Italy
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Freeman-Sanderson A, Hemsley B, Thompson K, Rogers KD, Knowles S, Hammond NE. Dysphagia in adult intensive care patients: Results of a prospective, multicentre binational point prevalence study. Aust Crit Care 2023; 36:961-966. [PMID: 36868933 DOI: 10.1016/j.aucc.2023.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/21/2022] [Accepted: 01/08/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Dysphagia occurs in intensive care unit (ICU) patients. However, there is a lack of epidemiological data on the prevalence of dysphagia in adult ICU patients. OBJECTIVES The objective of this study was to describe the prevalence of dysphagia in nonintubated adult patients in the ICU. METHODS A prospective, multicentre, binational, cross-sectional point prevalence study was conducted in 44 adult ICUs in Australia and New Zealand. Data were collected in June 2019 on documentation of dysphagia, oral intake, and ICU guidelines and training. Descriptive statistics were used to report demographic, admission, and swallowing data. Continuous variables are reported as means and standard deviations (SDs). Precisions of estimates were reported as 95% confidence intervals (CIs). RESULTS Of the 451 eligible participants, 36 (7.9%) were documented as having dysphagia on the study day. In the dysphagia cohort, the mean age was 60.3 years (SD: 16.37) vs 59.6 years (SD: 17.1) and almost two-thirds were female (61.1% vs 40.1%). The most common admission source for those patients with dysphagia were from the emergency department (14/36, 38.9%), and seven of 36 (19.4%) had a primary diagnosis of trauma (odds ratio: 3.10, 95% CI 1.25 - 7.66). There were no statistical differences in Acute Physiology and Chronic Health Evaluation (APACHE II) scores between those with and without a dysphagia diagnosis. Patients with dysphagia were more likely to have a lower mean body weight of 73.3 kg vs 82.1 kg than patients not documented as having dysphagia (95% CI of mean difference: 0.43 to 17.07) and require respiratory support (odds ratio: 2.12, 95% 1.06 to 4.25). The majority of patients with dysphagia were prescribed modified food and fluids in the ICU. Less than half of ICUs surveyed reported unit-level guidelines, resources, or training for management of dysphagia. CONCLUSIONS The prevalence of documented dysphagia in adult ICU nonintubated patients was 7.9%. There were a higher proportion of females with dysphagia than previously reported. Approximately two-thirds of patients with dysphagia were prescribed oral intake, and the majority were receiving texture-modified food and fluids. Dysphagia management protocols, resources, and training are lacking across Australian and New Zealand ICUs.
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Affiliation(s)
- Amy Freeman-Sanderson
- Graduate School of Health, University of Technology Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Australia.
| | - Bronwyn Hemsley
- Graduate School of Health, University of Technology Sydney, NSW, Australia; The University of Newcastle, NSW, Australia
| | - Kelly Thompson
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia; Nepean Blue Mountains Local Health District, Sydney, NSW, Australia
| | - Kris D Rogers
- Graduate School of Health, University of Technology Sydney, NSW, Australia; Statistics Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Serena Knowles
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Naomi E Hammond
- Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia
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Guauque-Olarte S, Cifuentes-C L, Fong C. Oral manifestations in patients with coronavirus disease 2019 (COVID-19) identified using text mining: an observational study. Sci Rep 2023; 13:17770. [PMID: 37853031 PMCID: PMC10584950 DOI: 10.1038/s41598-023-44784-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023] Open
Abstract
Text mining enables search, extraction, categorisation and information visualisation. This study aimed to identify oral manifestations in patients with COVID-19 using text mining to facilitate extracting relevant clinical information from a large set of publications. A list of publications from the open-access COVID-19 Open Research Dataset was downloaded using keywords related to oral health and dentistry. A total of 694,366 documents were retrieved. Filtering the articles using text mining yielded 1,554 oral health/dentistry papers. The list of articles was classified into five topics after applying a Latent Dirichlet Allocation (LDA) model. This classification was compared to the author's classification which yielded 17 categories. After a full-text review of articles in the category "Oral manifestations in patients with COVID-19", eight papers were selected to extract data. The most frequent oral manifestations were xerostomia (n = 405, 17.8%) and mouth pain or swelling (n = 289, 12.7%). These oral manifestations in patients with COVID-19 must be considered with other symptoms to diminish the risk of dentist-patient infection.
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Affiliation(s)
| | - Laura Cifuentes-C
- Faculty of Dentistry, Universidad Cooperativa de Colombia, Pasto, Colombia
| | - Cristian Fong
- Faculty of Medicine, Universidad Cooperativa de Colombia, Santa Marta, Colombia
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Bitencourt BS, Guedes JS, Saliba ASMC, Sartori AGO, Torres LCR, Amaral JEPG, Alencar SM, Maniglia BC, Augusto PED. Mineral bioaccessibility in 3D printed gels based on milk/starch/ĸ-carrageenan for dysphagic people. Food Res Int 2023; 170:113010. [PMID: 37316077 DOI: 10.1016/j.foodres.2023.113010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/16/2023]
Abstract
Dysphagia is a condition that affects the ability to chew and swallow food and beverages, having a major impact on people's health and wellbeing. This work developed gel systems with a customized texture suitable for intake by dysphagic people using 3D printing and milk. Gels were developed using skim powdered milk, cassava starch (native and modified by the Dry Heating Treatment (DHT)), and different concentrations of kappa-carrageenan (ĸC). The gels were evaluated in relation to the starch modification process and concentration of gelling agents, 3D printing performance, and suitability for dysphagic people (following both the standard fork test described by the International Dysphagia Diet Standardization Initiative (IDDSI), and also using a new device coupled to a texture analyzer). Moreover, the best formulations were evaluated for mineral bioaccessibility through simulated gastrointestinal digestion based on INFOGEST 2.0 standardized method. The results showed that ĸC had a dominant effect compared to the DHT-modified starch on gel texture, 3D printing performance, and fork tests. The gels obtained by molding or 3D printing resulted in different behaviors during the fork test, which was associated with the gel extrusion process that breaks down their initial structure. The strategies applied to tailor the texture of the milk did not affect the mineral bioaccessibility, which was kept high (>80%).
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Affiliation(s)
- B S Bitencourt
- Department of Agri-food Industry, Food and Nutrition (LAN), "Luiz de Queiroz" College of Agriculture (ESALQ), University of São Paulo (USP), Piracicaba, SP, Brazil
| | - J S Guedes
- Department of Agri-food Industry, Food and Nutrition (LAN), "Luiz de Queiroz" College of Agriculture (ESALQ), University of São Paulo (USP), Piracicaba, SP, Brazil
| | - A S M C Saliba
- Center of Nuclear Energy in Agriculture (CENA), University of São Paulo (USP), Piracicaba, SP, Brazil
| | - A G O Sartori
- Department of Agri-food Industry, Food and Nutrition (LAN), "Luiz de Queiroz" College of Agriculture (ESALQ), University of São Paulo (USP), Piracicaba, SP, Brazil
| | - L C R Torres
- Center of Nuclear Energy in Agriculture (CENA), University of São Paulo (USP), Piracicaba, SP, Brazil
| | - J E P G Amaral
- Center of Nuclear Energy in Agriculture (CENA), University of São Paulo (USP), Piracicaba, SP, Brazil
| | - S M Alencar
- Department of Agri-food Industry, Food and Nutrition (LAN), "Luiz de Queiroz" College of Agriculture (ESALQ), University of São Paulo (USP), Piracicaba, SP, Brazil; Center of Nuclear Energy in Agriculture (CENA), University of São Paulo (USP), Piracicaba, SP, Brazil
| | - B C Maniglia
- Instituto de Química de São Carlos (IQSC), Universidade de São Paulo (USP), São Carlos, SP, Brazil
| | - P E D Augusto
- Université Paris-Saclay, CentraleSupélec, Laboratoire de Génie des Procédés et Matériaux, Centre Européen de Biotechnologie et de Bioéconomie (CEBB), 3 rue des Rouges Terres 51110 Pomacle, France.
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9
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Dimitriadis K, Schmidbauer M, Bösel J. [Neurointensive care medicine and COVID-19]. DER NERVENARZT 2023; 94:84-92. [PMID: 36520214 PMCID: PMC9751507 DOI: 10.1007/s00115-022-01417-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/16/2022]
Abstract
This review article summarizes important findings on the interfaces between the coronavirus disease 2019 (COVID-19) pandemic and neurology with an emphasis of the implications for neurointensive care medicine. More specifically, the prevalence, pathomechanisms and impact of neurological manifestations are reported. The most common neurological manifestations of critically ill COVID-19 patients are cerebrovascular complications, encephalopathies and intensive care unit-acquired weakness (ICUAW). A relevant direct pathophysiological effect by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) itself has not yet been established with certainty. In fact, indirect systemic inflammatory processes triggered by the viral infection and side effects of intensive care treatment are much more likely to cause the reported sequelae. The impact of the pandemic on patients with neurological disorders and neurointensive care medicine is far-reaching but not yet sufficiently studied.
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Affiliation(s)
- Konstantinos Dimitriadis
- Neurologische Klinik, Universitätsklinikum LMU München, München, Deutschland.
- Institut für Schlaganfall- und Demenzforschung (ISD), LMU München, Feodor-Lynen-Str. 17, 81377, München, Deutschland.
| | - Moritz Schmidbauer
- Neurologische Klinik, Universitätsklinikum LMU München, München, Deutschland
| | - Julian Bösel
- Neurologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Lin TY, Shen PC, Lee SA, Yeh SM, Chang KV, Wang TG. Case report: Dysphagia after COVID-19 infection in a stroke patient-Is neurostimulation a potential management? Front Neurol 2023; 14:1126390. [PMID: 36949856 PMCID: PMC10025385 DOI: 10.3389/fneur.2023.1126390] [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: 12/22/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023] Open
Abstract
A 90-year-old man with stroke was weaned from tube feeding 4 months after stroke onset. However, he had a coronavirus disease 2019 (COVID-19) infection after 2 months and suffered from drastically worsened oropharyngeal dysphagia that required a reinsertion of the nasogastric tube. A videofluoroscopic swallowing study revealed poor bolus oral transit, significantly delayed swallowing reflex, reduced pharyngeal movements, and insufficient cough response. Repetitive transcranial magnetic stimulation and neuromuscular electrical stimulation were applied, in addition to conventional swallowing training. The feeding tube was removed after 20 treatment sessions. Clinicians should be aware of the risk of dysphagia after COVID-19 infection in patients with underlying neurological diseases. The management of post-COVID-19 dysphagia has not yet been fully established. Repetitive transcranial electrical stimulation combined with neuromuscular electrical stimulation may be used as an auxiliary intervention in specific cases.
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Affiliation(s)
- Ting-Yu Lin
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan City, Taiwan
| | - Peng-Chieh Shen
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan City, Taiwan
| | - Shao-An Lee
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan City, Taiwan
| | - Shu-Ming Yeh
- Department of Physical Medicine and Rehabilitation, Lo-Hsu Medical Foundation, Inc., Lotung Poh-Ai Hospital, Yilan City, Taiwan
- *Correspondence: Shu-Ming Yeh
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
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11
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Yang X, Shi L, Ran D, Li M, Qin C, An Z. The treatment of post-stroke dysarthria with a combination of different acupuncture types and language rehabilitation training: a systematic review and network meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1281. [PMID: 36618810 PMCID: PMC9816828 DOI: 10.21037/atm-22-5583] [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] [Received: 10/26/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
Background This study used a network meta-analysis to evaluate the efficacy of various different acupuncture types and language rehabilitation training on post-stroke dysarthria (PSD), and examined the possible mechanisms involved. There are often clinical studies comparing the effects of different acupuncture methods on dysarthria after stroke. The efficacy of these methods can be ranked by network meta-analysis. This is necessary for clinical acupoints selection. The results of this study illustrated the comparison of the therapeutic effects of 6 different acupuncture types, which can provide some reference for clinical acupoints selection and research. Methods A comprehensive search for clinical studies related to the use of acupuncture to treat PSD was conducted in eight English and Chinese databases. Patients were divided into six groups based on the acupoints selected, namely, tongue, neck, scalp, body, combination, and traditional acupuncture. The recovery of neurological function in the patients was assessed based on the curative impact and the National Institutes of Health Stroke Scale (NIHSS) score. The quality of the included studies was evaluated using the Cochrane risk bias assessment tool and the STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) criteria. A network meta-analysis was performed using the network-meta package of Stata 15.1 software based on frequency. The heterogeneity test, consistency test, head-to-head mixed comparison, efficacy ranking, and publication bias study were all performed. Results A total of 47 studies were finally included. There was a total of 4,197 patients in the eligible studies. The model for network meta-analysis proved robust, with minimal heterogeneity and high consistency. Combined acupuncture combined with language rehabilitation training was the most effective in treating dysarthria symptoms, followed by tongue acupuncture (TA) and nape acupuncture (NA). In addition, the combined effect of acupuncture and language training was superior to that of acupuncture alone. In terms of recovery of nerve function, traditional acupuncture and body acupuncture were more effective. To facilitate the recovery of nerve function, increasing the frequency of acupoints is necessary. Conclusions Combined acupuncture may have the most beneficial healing effect on PSD, followed by acupuncture of the tongue and the nape of the neck. In terms of recovery of nerve function, traditional acupuncture and body acupuncture may have more effective.
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Affiliation(s)
- Xinming Yang
- Clinical Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Lei Shi
- Clinical Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Dawei Ran
- Clinical Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Menghan Li
- Clinical Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chenyang Qin
- Clinical Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Zimeng An
- Clinical Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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12
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Martin-Martinez A, Ortega O, Viñas P, Arreola V, Nascimento W, Costa A, Riera SA, Alarcón C, Clavé P. COVID-19 is associated with oropharyngeal dysphagia and malnutrition in hospitalized patients during the spring 2020 wave of the pandemic. Clin Nutr 2022; 41:2996-3006. [PMID: 34187698 PMCID: PMC8205257 DOI: 10.1016/j.clnu.2021.06.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Prevalence and complications of oropharyngeal dysphagia (OD) and malnutrition (MN) in COVID-19 patients is unknown. Our aim was to assess the prevalence, risk factors and clinical outcomes of OD and MN in a general hospital during the first wave of the COVID-19 pandemic. METHODS This was a prospective, observational study involving clinical assessment of OD (Volume-Viscosity Swallowing Test), and nutritional screening (NRS2002) and assessment (GLIM criteria) in COVID-19 patients hospitalized in general wards at the Consorci Sanitari del Maresme, Catalonia, Spain. The clinical characteristics and outcomes of patients were assessed at pre-admission, admission and discharge, and after 3 and 6-months follow-up. RESULTS We included 205 consecutive patients (69.28 ± 17.52 years, Charlson 3.74 ± 2.62, mean hospital stay 16.8 ± 13.0 days). At admission, Barthel Index was 81.3 ± 30.3; BMI 28.5 ± 5.4 kg/m2; OD prevalence 51.7% (44.1% impaired safety of swallow); and 45.5% developed MN with a mean weight loss of 10.1 ± 5.0 kg during hospitalization. OD was an independent risk factor for MN during hospitalization (OR 3.96 [1.45-10.75]), and hospitalization was prolonged in patients with MN compared with those without (21.9 ± 14.8 vs 11.9 ± 8.9 days, respectively; p < 0.0001). OD was independently associated with comorbidities, neurological symptoms, and low functionality. At 6-month follow-up, prevalence of OD was still 23.3% and that of MN only 7.1%. Patients with OD at discharge showed reduced 6-month survival than those without OD at discharge (71.6% vs 92.9%, p < 0.001); in contrast, those with MN at discharge did not show 6-month survival differences compared to those without (85.4% vs 83.8%, p = 0.8). CONCLUSIONS Prevalence and burden of OD and MN in patients hospitalized in COVID-19 wards is very high. Our results suggest that optimizing the management of MN might shorten the hospitalization period but optimizing the management of OD will likely impact the nutritional status of COVID-19 patients and improve their clinical outcomes and survival after hospital discharge. CLINICALTRIALS gov Identifier: NCT04346212.
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Affiliation(s)
- Alberto Martin-Martinez
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Paula Viñas
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Viridiana Arreola
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Weslania Nascimento
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Alícia Costa
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Stephanie A Riera
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Claudia Alarcón
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
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13
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Viñas P, Martín-Martínez A, Alarcón C, Riera SA, Miró J, Amadó C, Clavé P, Ortega O. A Comparative Study between the Three Waves of the Pandemic on the Prevalence of Oropharyngeal Dysphagia and Malnutrition among Hospitalized Patients with COVID-19. Nutrients 2022; 14:3826. [PMID: 36145215 PMCID: PMC9502091 DOI: 10.3390/nu14183826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The phenotype of patients affected by COVID-19 disease changed between the waves of the pandemic. We assessed the prevalence of oropharyngeal dysphagia (OD), malnutrition (MN), and mortality between the first three waves of COVID-19 patients in a general hospital. METHODS a prospective observational study between April 2020-May 2021. Clinical assessment for OD was made with the volume-viscosity swallowing test; nutritional assessment was performed consistent with GLIM criteria. A multimodal intervention was implemented in the second and third wave, including (a) texturized diets-fork mashable (1900 kcal + 90 g protein) or pureed (1700 kcal + 75 g protein), (b) oral nutritional supplements (500-600 kcal + 25-30 g protein), and (c) fluid thickening (250 mPa·s or 800 mPa·s). RESULTS We included 205 patients (69.3 ± 17.6 years) in the 1st, 200 (66.4 ± 17.5 years) in the 2nd, and 200 (72.0 ± 16.3 years;) in the 3rd wave (p = 0.004). On admission, prevalence of OD was 51.7%, 31.3% and 35.1%, and MN, 45.9%, 36.8% and 34.7%, respectively; mortality was 10.7%, 13.6% and 19.1%. OD was independently associated with age, delirium, and MN; MN, with age, OD, diarrhea and ICU admission; mortality, with age, OD and MN. (4) Conclusions: Prevalence of OD, MN and mortality was very high among COVID-19 patients. OD was independently associated with MN and mortality. An early and proactive multimodal nutritional intervention improved patients' nutritional status.
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Affiliation(s)
- Paula Viñas
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Alberto Martín-Martínez
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Claudia Alarcón
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Stephanie A. Riera
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Jaume Miró
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Cristina Amadó
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
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Almeida VPB, Félix L, Tavares TL, da Silva Castro MM, Tiago RSL. Dysphagia in patients with coronavirus disease undergoing orotracheal intubation. Laryngoscope Investig Otolaryngol 2022; 7:LIO2886. [PMID: 36249087 PMCID: PMC9538553 DOI: 10.1002/lio2.886] [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: 04/13/2022] [Revised: 07/06/2022] [Accepted: 07/23/2022] [Indexed: 01/08/2023] Open
Abstract
Objective To assess the incidence and the risk factors for the development of dysphagia in patients with coronavirus disease 2019 (COVID-19) undergoing orotracheal intubation. Study Design Prospective cohort study. Methods In this prospective cohort study, we evaluated consecutive patients diagnosed with COVID-19 and underwent orotracheal intubation were evaluated. During hospitalization, extubated patients were classified as dysphagic and nondysphagic based on bedside functional assessment of swallowing. Patients discharged from hospital were asked to complete the Eating Assessment Tool-10 (EAT-10) questionnaire, followed by an endoscopic examination to identify laryngotracheal lesions, and a fiberoptic endoscopic evaluation of swallowing (FEES). The food consistencies used for FEES were moderately thick, extremely thick, thin, and regular. Results Based on the functional assessment of swallowing, performed a mean of 5.3 days and a median of 4 days after extubation, the incidence of dysphagia in patients with COVID-19 undergoing orotracheal intubation was 53.6%. In the late evaluation, performed a mean of 102 days after extubation, 12.8% of patients had an EAT-10 score >2. Orotracheal intubation (OTI) duration and tracheostomy were risk factors for the development of dysphagia. There was an association between EAT-10 > 2 and the presence of laryngotracheal lesion, with no difference between lesion type and EAT score >2. Conclusions The incidence of dysphagia varied according to the time of assessment, being higher the earlier the assessment after extubation. OTI duration and tracheostomy were risk factors for the development of dysphagia, and the presence of laryngotracheal lesions demonstrated an association with dysphagia. Level of Evidence 3.
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Affiliation(s)
- Vinícius Pereira Barbosa Almeida
- Otorhinolaryngology Service, Department of Laryngology and Cervicofacial SurgeryInstitute of Medical Assistance to the State Public Servant (IAMSPE)São PauloBrazil
| | - Letícia Félix
- Otorhinolaryngology Service, Department of Laryngology and Cervicofacial SurgeryInstitute of Medical Assistance to the State Public Servant (IAMSPE)São PauloBrazil
| | - Tracy Lima Tavares
- Otorhinolaryngology Service, Department of Laryngology and Cervicofacial SurgeryInstitute of Medical Assistance to the State Public Servant (IAMSPE)São PauloBrazil
| | - Mariana Marques da Silva Castro
- Otorhinolaryngology Service, Department of Laryngology and Cervicofacial SurgeryInstitute of Medical Assistance to the State Public Servant (IAMSPE)São PauloBrazil
| | - Romualdo Suzano Louzeiro Tiago
- Otorhinolaryngology Service, Department of Laryngology and Cervicofacial SurgeryInstitute of Medical Assistance to the State Public Servant (IAMSPE)São PauloBrazil
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15
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Pu D, Zhai X, Zhou Y, Xie Y, Tang L, Yin L, Liu H, Li L. A narrative review of COVID-19-related acute respiratory distress syndrome (CARDS): "typical" or "atypical" ARDS? ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:908. [PMID: 36111011 PMCID: PMC9469157 DOI: 10.21037/atm-22-3717] [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] [Received: 07/14/2022] [Accepted: 08/08/2022] [Indexed: 11/06/2022]
Abstract
Background and Objective The coronavirus disease of 2019 (COVID-19) is highly infectious and mainly involves the respiratory system, with some patients rapidly progress to acute respiratory distress syndrome (ARDS), which is the leading cause of death in COVID-19 patients. Hence, fully understanding the features of COVID-19-related ARDS (CARDS) and early management of this disease would improve the prognosis and reduce the mortality of severe COVID-19. With the development of recent studies which have focused on CARDS, whether CARDS is "typical" or "atypical" ARDS has become a hotly debated topic. Methods We searched for relevant literature from 1999 to 2021 published in PubMed by using the following keywords and their combinations: "COVID-19", "CARDS", "ARDS", "pathophysiological mechanism", "clinical manifestations", "prognosis", and "clinical trials". Then, we analyzed, compared and highlighted the differences between classic ARDS and CARDS from all of the aspects above. Key Content and Findings Classical ARDS commonly occurs within 1 week after a predisposing cause, yet the median time from symptoms onset to CARDS is longer than that of classical ARDS, manifesting within a period of 9.0-12.0 days. Although the lung mechanics exhibited in CARDS grossly match those of classical ARDS, there are some atypical manifestations of CARDS: the severity of hypoxemia seemed not to be proportional to injury of lung mechanics and an increase of thrombogenic processes. Meanwhile, some patients' symptoms do not correspond with the extent of the organic injury: a chest computed tomography (CT) will reveal the severe and diffuse lung injuries, yet the clinical presentations of patients can be mild. Conclusions Despite the differences between the CARDS and ARDS, in addition to the treatment of antivirals, clinicians should continue to follow the accepted evidence-based framework for managing all ARDS cases, including CARDS.
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Affiliation(s)
- Dan Pu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoqian Zhai
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yuwen Zhou
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Xie
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Liansha Tang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Liyuan Yin
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hangtian Liu
- Data Science and Big Data Technology, Chengdu University of Information Technology, Chengdu, China
| | - Lu Li
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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16
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Nascimento Junior JRD, Ceron CF, Signorini AV, Klein AB, Castelli CTR, Silvério CC, Otto DM, Antunes HDA, Sotero LKB, Cirino PB, Vizioli PT, Lima VC. DYSPHAGIA OCCURRENCE IN COVID-19-POSITIVE PATIENTS IN TWO HOSPITALS IN BRAZIL. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:439-446. [PMID: 36102445 DOI: 10.1590/s0004-2803.202203000-78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND COVID-19 comprises a respiratory infection resulting from contamination by SARS-CoV-2, with acute respiratory failure being one of its main characteristics, leading to a high frequency of orotracheal intubation (OTI), which in turn increases the risk for dysphagia. Since this can lead to pulmonary impairment, knowing the real occurrence of dysphagia in part of the Brazilian population and its associations allows early and effective clinical management of the multidisciplinary team in relation to patients. OBJECTIVE To verify the occurrence of dysphagia in COVID-19-positive adult patients in two Brazilian reference hospitals in the care of the pandemic. METHODS This was a prospective, longitudinal observational study carried out in two private hospitals in Brazil, both references in the care of patients with coronavirus isolation. Data were initially collected by consulting the medical records of each patient. Information was collected regarding sex, age, previous diseases, COVID-19 testing, and the OTI period. After data collection, the clinical speech-language assessment of swallowing for each patient was carried out using the adapted Gugging Swallowing Screen (GUSS), the ASHA NOMS and the Functional Oral Intake Scale (FOIS). RESULTS A total of 129 participants were evaluated, with a mean age of 72 years. According to the GUSS scale, 9.3% of the patients presented normal/functional swallowing, while 90.7% presented dysphagia, with mild dysphagia in 17.05%, moderate dysphagia in 33.33%, and severe dysphagia in 37.98%. As for the results of the ASHA NOMS, the majority (36.5%) of the patients were at level 1, which represents the patient who is not able to receive his or her food supply orally, having the need to use tube feedings. This is in line with the results observed with the FOIS scale, whereby most patients (42.1%) were classified as Level I, when food intake occurs exclusively through feeding tubes, with no oral supply. Of the 129 participants, 59% of them required OTI. When comparing the time of OTI and the severity of dysphagia, there was a statistically significant difference, with more severe dysphagia, the longer the patient remained intubated. CONCLUSION There is a high incidence of oropharyngeal dysphagia in patients with COVID-19, with increased severity during longer periods of OTI.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Paula Tasca Vizioli
- Hospital Moinhos de Vento, Serviço de Fonoaudiologia, Porto Alegre, RS, Brasil
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Dysphagia incidence in intensive care unit patients with coronavirus disease 2019: retrospective analysis following systematic dysphagia screening. J Laryngol Otol 2022; 136:1278-1283. [DOI: 10.1017/s0022215122001517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objective
Post-extubation dysphagia in critically ill patients is known to affect about 18 per cent of mixed medical-surgical intensive care unit patients. This study investigated the incidence of post-extubation dysphagia in adult intensive care unit patients with coronavirus disease 2019.
Method
This study was a retrospective analysis of consecutive intensive care unit patients prospectively screened for dysphagia. Systematic screening of all extubated intensive care unit patients at our tertiary centre was performed using the Bernese intensive care unit dysphagia algorithm. The primary outcome measure was the incidence of post-extubation dysphagia.
Results
A total of 231 critically ill adult coronavirus disease 2019 positive patients were included, and 81 patients remained in the final analysis after exclusion criteria were applied (e.g. patients transferred). Dysphagia screening positivity was 25 of 81 (30.9 per cent), with 28.2 per cent (22 of 78) having confirmed dysphagia by specialist examination within 24 hours (n = 3 lost to follow up).
Conclusion
In this observational study, it was observed that the incidence of dysphagia in adult critically ill coronavirus disease 2019 patients was about 31 per cent (i.e. increased when compared with a historical pre-pandemic non-coronavirus disease 2019 intensive care unit cohort).
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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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19
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Frank U, Frank K. [COVID-19-New challenges in dysphagia and respiratory therapy]. DER NERVENARZT 2022; 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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/21/2022]
Abstract
Coronavirus disease 2019 (COVID-19) can lead to severe disease courses with multiple organ involvement, respiratory and neurological functional impairments. Swallowing disorders (dysphagia) in this patient group can result from primary damage to the central and peripheral neuronal swallowing network but also from the frequently prolonged intensive care treatment and mechanical ventilation. Clinical observations indicate persistence of dysphagia in post-acute COVID-19 syndrome (long COVID), so that these patients probably also need long-term interventions for rehabilitation of safe and sufficient oral feeding. Therefore, structured disease-specific monitoring of dysphagia symptoms should be integrated into the treatment of COVID-19 patients and respiratory therapy should be an essential part of dysphagia management to re-establish cough effectiveness and breathing-swallowing coordination. Challenges arise from necessary adjustments to established treatment standards to prevent infections. Furthermore, the selection and intensity of therapeutic measures have to be adapted to the capacities and the specific pathophysiology of COVID-19 and long COVID patients to prevent further functional deterioration.
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Affiliation(s)
- Ulrike Frank
- Department Linguistik, Swallowing Research Lab, Universität Potsdam, Karl-Liebknecht-Str. 24-25, 14.202, 14476, Potsdam, Deutschland.
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Chuang HJ, Hsiao MY, Wang TG, Liang HW. A multi-disciplinary rehabilitation approach for people surviving severe COVID-19—a case series and literature review. J Formos Med Assoc 2022; 121:2408-2415. [PMID: 35216882 PMCID: PMC8841152 DOI: 10.1016/j.jfma.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/23/2021] [Accepted: 02/06/2022] [Indexed: 01/08/2023] Open
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Braun T, Doerr JM, Peters L, Viard M, Reuter I, Prosiegel M, Weber S, Yeniguen M, Tschernatsch M, Gerriets T, Juenemann M, Huttner HB, Hamzic S. Age-related changes in oral sensitivity, taste and smell. Sci Rep 2022; 12:1533. [PMID: 35087097 PMCID: PMC8795375 DOI: 10.1038/s41598-022-05201-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/06/2022] [Indexed: 11/11/2022] Open
Abstract
Oropharyngeal sensitivity plays a vital role in the initiation of the swallowing reflex and is thought to decline as part of the aging-process. Taste and smell functions appear to decline with age as well. The aim of our study was to generate data of oral sensitivity in healthy participants for future studies and to analyse age-related changes and their interdependence by measuring oral sensitivity, taste, and smell function. The experiment involved 30 participants younger than and 30 participants older than 60. Sensitivity threshold as a surrogate of oral sensitivity was measured at the anterior faucial pillar by electrical stimulation using commercially available pudendal electrode mounted on a gloved finger. Smell and taste were evaluated using commercially available test kits. Mean sensitivity was lower in young participants compared to older participants (1.9 ± 0.59 mA vs. 2.42 ± 1.03 mA; p = 0.021). Young participants also performed better in smell (Score 11.13 ± 0.86 vs 9.3 ± 1.93; p < 0.001) and taste examinations (Score 11.83 ± 1.86 vs 8.53 ± 3.18; p < 0.001). ANCOVA revealed a statistical association between sensitivity and smell (p = 0.08) that was moderated by age (p = 0.044). Electrical threshold testing at the anterior faucial pillar is a simple, safe, and accurate diagnostic measure of oral sensitivity. We detected a decline of oral sensitivity, taste, and smell in older adults.Trial registration: Clinicaltrials.gov, NCT03240965. Registered 7th August 2017- https://clinicaltrials.gov/ct2/show/NCT03240965 .
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Affiliation(s)
- Tobias Braun
- Department of Neurology, University Hospital Giessen and Marburg, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Johanna M Doerr
- Department of Neurology, University Hospital Giessen and Marburg, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
| | - Laura Peters
- Justus-Liebig-University Giessen, Faculty of Medicine, Klinikstrasse 29, 35392, Giessen, Germany
| | - Maxime Viard
- Department of Neurology, University Hospital Giessen and Marburg, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
| | - Iris Reuter
- Department of Neurology, University Hospital Giessen and Marburg, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
| | - Mario Prosiegel
- Faculty of Languages and Literatures, Department I, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Susanne Weber
- Stroke Unit, Buergerhospital Friedberg, Ockstaedter Str. 3-5, 61169, Friedberg, Germany
| | - Mesut Yeniguen
- Department of Neurology, University Hospital Giessen and Marburg, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
| | - Marlene Tschernatsch
- Department of Neurology, University Hospital Giessen and Marburg, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
- Department of Neurology, Gesundheitszentrum Wetterau, Chaumontplatz 1, 61231, Bad Nauheim, Germany
| | - Tibo Gerriets
- Department of Neurology, University Hospital Giessen and Marburg, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
- Stroke Unit, Buergerhospital Friedberg, Ockstaedter Str. 3-5, 61169, Friedberg, Germany
- Department of Neurology, Gesundheitszentrum Wetterau, Chaumontplatz 1, 61231, Bad Nauheim, Germany
| | - Martin Juenemann
- Department of Neurology, University Hospital Giessen and Marburg, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
| | - Hagen B Huttner
- Department of Neurology, University Hospital Giessen and Marburg, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
| | - Samra Hamzic
- Department of Neurology, University Hospital Giessen and Marburg, Justus Liebig University, Klinikstrasse 33, 35392, Giessen, Germany
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Self-perceived dysphagia in non-invasively ventilated COVID-19 patients. Eur Arch Otorhinolaryngol 2022; 279:5929-5937. [PMID: 35947148 PMCID: PMC9363266 DOI: 10.1007/s00405-022-07557-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/12/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE COVID-19 is known to present with a wide range of clinical symptoms. COVID-19-related dysphagia has been frequently investigated in patients who were critically ill and mechanically ventilated, but not in those with less severe presentations. This study aims to identify the frequency, characteristics, and severity of self-perceived oropharyngeal dysphagia in non-intubated COVID-19 patients. METHODS In this cross-sectional study, data were collected from patients using a self-administered questionnaire that included the Eating Assessment Tool (EAT-10). RESULTS The study included 359 participants with a median age of 34 (range: 18-65) years. Self-perceived dysphagia (EAT-10 total score > 2) was identified in 64.62%, and their median EAT-10 total score was 13 (range 3-40). The most prevalent symptoms were painful swallowing, affected pleasure of eating, stressful swallowing, and coughing while eating. Age, gender, and hospitalization were not statistically significantly associated with the presence of dysphagia, while re-infection, duration, and severity of COVID-19 diagnosis were. The EAT-10 total score was higher in moderate and severe COVID-19 cases as compared to mild cases, and showed a statistically significant inverse correlation with the duration of COVID-19 (r = - 0.267). CONCLUSION Self-perceived dysphagia was prevalent in non-intubated COVID-19 patients. Its severity was related to that of COVID-19 and its duration.
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Yamada Y, Kawakami M, Tashiro S, Omori M, Matsuura D, Abe R, Osada M, Tashima H, Shimomura T, Mori N, Wada A, Ishikawa A, Tsuji T. Rehabilitation in acute COVID-19 patients: A Japanese retrospective, observational, multi-institutional survey. Arch Phys Med Rehabil 2021; 103:929-936. [PMID: 34896082 PMCID: PMC8651527 DOI: 10.1016/j.apmr.2021.11.004] [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: 10/25/2021] [Accepted: 11/14/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To investigate the changes in activities of daily living (ADLs) and the conditions of rehabilitation for acute COVID-19 patients in Japan. DESIGN Retrospective, observational survey. SETTING Four tertiary hospitals with intensive care units and one secondary hospital in Japan. PATIENTS COVID-19 patients (N=478) admitted to five hospitals INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES Walking ability and swallowing status were assessed using the Functional Independence Measure (FIM) locomotion item and Food Intake Scale (FILS) at admission and discharge. The physiatrists of each hospital were also surveyed regarding the factors that influenced decisions to provide rehabilitation. RESULTS Excluding patients who died, the proportion of critical patients who could walk independently at discharge was 63%, and the proportion of those who were able to take three meals orally at discharge was 90%. Rehabilitation was provided to 13.4% of all patients, in particular to 58.3% of patients with critical symptoms. CONCLUSIONS After COVID-19 treatment, patients, especially those with critical symptoms, still have functional disabilities related to walking and swallowing. During the period studied, it is possible that sufficient rehabilitation could not be provided.
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Affiliation(s)
- Yuka Yamada
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Syoichi Tashiro
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Maiko Omori
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Daisuke Matsuura
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Brain Attack Center Ota Memorial Hospital, Hiroshima, Japan
| | - Reon Abe
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Maiko Osada
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan
| | - Hiroyuki Tashima
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tadasuke Shimomura
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Rehabilitation Medicine, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan
| | - Naoki Mori
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ayako Wada
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Aiko Ishikawa
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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Dysphagia management during COVID-19 pandemic: A review of the literature and international guidelines. Turk J Phys Med Rehabil 2021; 67:267-274. [PMID: 34870112 DOI: 10.5606/tftrd.2021.8427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/20/2021] [Indexed: 02/07/2023] Open
Abstract
In this review, we present the safest and most effective diagnosis and treatment approaches to dysphagia during the novel coronavirus-2019 (COVID-19) pandemic in the light of available data, relevant literature, and personal experiences. Evaluations for dysphagia patients should be based on clinical assessment during the COVID-19 pandemic and instrumental assessment should be planned for very few number of patients. The main approach to rehabilitation must depend on compensatory methods, texture-modified foods, and postural strategies. Direct treatment methods should be avoided and home-based exercise programs should be encouraged. It is also obvious that there is a need for the development of new strategies for telemedicine/telerehabilitation practices in the new world order.
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Dysphagia Severity and Management in Patients with COVID-19. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:147-156. [PMID: 34765231 PMCID: PMC8551886 DOI: 10.12865/chsj.47.02.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/07/2021] [Indexed: 11/18/2022]
Abstract
COVID-19 has resulted in unprecedented numbers of patients treated at intensive care units (ICUs). Dysphagia is a key concern in critical illness survivors. We investigated the severity of dysphagia in COVID-19 and the need to adapt practices to provide efficient care. We reviewed the literature on COVID-19, post-critical-illness dysphagia, and dysphagia and tracheostomy guidelines during the pandemic. Critically ill COVID-19 patients present a high incidence of dysphagia, aggravated by respiratory distress, deconditioning, and neurological complications. Mechanical ventilation (MV), delirium, sedation and weakness are worse in COVID-19 than in other etiologies of critical care. In awake patients, respiratory compromise impairs breathing-swallowing-coughing coordination. Tracheostomy reduces laryngopharyngeal trauma, sedation, delirium, ICU stay and improves swallowing rehabilitation. Tracheostomy weaning and swallowing evaluation is complex in COVID-19 due to respiratory instability and a team discussion will guide adaptations. Patients assessed in the ICU were 67% recommended to be nil by mouth (were aspirating). Two months following hospital discharge, 83% of those who had undergone tracheostomy were managing a normal diet. Severely ill COVID-19 patients are expected to regain swallow function. Dysphagia care is based on adaptation of practices to the patients' multiple impairments.
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Regan J, Walshe M, Lavan S, Horan E, Murphy PG, Healy A, Langan C, Malherbe K, Murphy BF, Cremin M, Hilton D, Cavaliere J, Curley J, Moloney A, Flanagan G, Whyte A. Dysphagia, Dysphonia, and Dysarthria Outcomes Among Adults Hospitalized With COVID-19 Across Ireland. Laryngoscope 2021; 132:1251-1259. [PMID: 34622966 PMCID: PMC8662217 DOI: 10.1002/lary.29900] [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: 06/28/2021] [Revised: 09/15/2021] [Accepted: 10/05/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate the presence, degree, predictors, and trajectory of dysphagia, dysphonia, and dysarthria among adults hospitalized with COVID-19 across the Republic of Ireland (ROI) during the first wave of the pandemic. STUDY DESIGN Prospective observational cohort study. METHODS Adults with confirmed COVID-19 who were admitted into 14 participating acute hospitals across ROI and referred to speech and language therapy between March 1st and June 30th, 2020 were recruited. Outcomes obtained at initial SLT evaluation and at discharge were oral intake status (Functional Oral Intake Scale), perceptual voice quality (GRBAS), and global dysarthria rating (Dysarthria Severity Scale). RESULTS Data from 315 adults were analyzed. At initial SLT assessment, 84% required modified oral diets, and 31% required tube feeding. There were high rates of dysphonia (42%) and dysarthria (23%). History of intubation (OR 19.959, 95% CI 6.272, 63.513; P = .000), COVID-19 neurological manifestations (OR 3.592, 95% CI 1.733, 7.445; P = .001), and age (OR 1.034; 95% CI 1.002, 1.066; P = .036) were predictive of oral intake status. History of intubation was predictive of voice quality (OR 4.250, 95% CI 1.838, 9.827; P = .001) and COVID-19 neurological manifestations were predictive of dysarthria (OR 2.275; 95% CI 1.162, 4.456; P = .017). At discharge, there were significant improvements in oral intake (Z = -7.971; P = .000), voice quality (Z = -5.971; P = .000), and dysarthria severity (Z = -2.619; P = .009), although need for modified oral intake (59%), dysphonia (23%), and dysarthria (14%) persisted. CONCLUSION Dysphagia, dysphonia, and dysarthria were widespread among adults hospitalized with COVID-19 and they persisted for many at discharge. Prompt SLT evaluation is required to minimize complications. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Sarah Lavan
- Speech and Language Therapy Department, St. James' Hospital, Dublin, Ireland
| | - Eanna Horan
- Speech and Language Therapy Department, Tallaght University Hospital, Dublin, Ireland
| | - Patricia Gillivan Murphy
- Speech and Language Therapy Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Anne Healy
- Speech and Language Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Caoimhe Langan
- Speech and Language Therapy Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Karen Malherbe
- Speech and Language Therapy Department, Galway University Hospital, Galway, Ireland
| | - Breda Flynn Murphy
- Speech and Language Therapy Department, Midland Regional Hospital Tullamore & Portlaoise, Offaly, Ireland
| | - Maria Cremin
- Speech and Language Therapy Department, University Hospital Kerry, Kerry, Ireland
| | - Denise Hilton
- Speech and Language Therapy Department, Cavan General Hospital, Cavan, Ireland
| | - Jenni Cavaliere
- Speech and Language Therapy Department, University Hospital Waterford, Waterford, Ireland
| | - Jacinta Curley
- Speech and Language Therapy Department, Wexford General Hospital, Wexford, Ireland
| | - Andrea Moloney
- Speech and Language Therapy Department, St. Luke's Hospital, Kilkenny, Ireland
| | - Grace Flanagan
- Speech and Language Therapy Department, Sligo University Hospital, Sligo, Ireland
| | - Alice Whyte
- Speech and Language Therapy Department, Naas General Hospital, Kildare, Ireland
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Regan J, Walshe M, Lavan S, Horan E, Gillivan Murphy P, Healy A, Langan C, Malherbe K, Flynn Murphy B, Cremin M, Hilton D, Cavaliere J, Whyte A. Post-extubation dysphagia and dysphonia amongst adults with COVID-19 in the Republic of Ireland: A prospective multi-site observational cohort study. Clin Otolaryngol 2021; 46:1290-1299. [PMID: 34197688 PMCID: PMC8444742 DOI: 10.1111/coa.13832] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/14/2021] [Accepted: 06/20/2021] [Indexed: 12/16/2022]
Abstract
Objectives This study aims to (i) investigate post‐extubation dysphagia and dysphonia amongst adults intubated with SARS‐COV‐2 (COVID‐19) and referred to speech and language therapy (SLT) in acute hospitals across the Republic of Ireland (ROI) between March and June 2020; (ii) identify variables predictive of post‐extubation oral intake status and dysphonia and (iii) establish SLT rehabilitation needs and services provided to this cohort. Design A multi‐site prospective observational cohort study. Participants One hundred adults with confirmed COVID‐19 who were intubated across eleven acute hospital sites in ROI and who were referred to SLT services between March and June 2020 inclusive. Main Outcome Measures Oral intake status, level of diet modification and perceptual voice quality. Results Based on initial SLT assessment, 90% required altered oral intake and 59% required tube feeding with 36% not allowed oral intake. Age (OR 1.064; 95% CI 1.018–1.112), proning (OR 3.671; 95% CI 1.128–11.943) and pre‐existing respiratory disease (OR 5.863; 95% CI 1.521–11.599) were predictors of oral intake status post‐extubation. Two‐thirds (66%) presented with dysphonia post‐extubation. Intubation injury (OR 10.471; 95% CI 1.060–103.466) and pre‐existing respiratory disease (OR 24.196; 95% CI 1.609–363.78) were predictors of post‐extubation voice quality. Thirty‐seven per cent required dysphagia intervention post‐extubation, whereas 20% needed intervention for voice. Dysphagia and dysphonia persisted in 27% and 37% cases, respectively, at hospital discharge. Discussion Post‐extubation dysphagia and dysphonia were prevalent amongst adults with COVID‐19 across the ROI. Predictors included iatrogenic factors and underlying respiratory disease. Prompt evaluation and intervention is needed to minimise complications and inform rehabilitation planning.
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Affiliation(s)
- Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Sarah Lavan
- Speech and Language Therapy Department, St. James' Hospital, Dublin, Ireland
| | - Eanna Horan
- Speech and Language Therapy Department, Tallaght University Hospital, Dublin, Ireland
| | - Patricia Gillivan Murphy
- Speech and Language Therapy Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Anne Healy
- Speech and Language Therapy Department, Beaumont Hospital, Dublin, Ireland
| | - Caoimhe Langan
- Speech and Language Therapy Department, St. Vincent's University Hospital, Dublin, Ireland
| | - Karen Malherbe
- Speech and Language Therapy Department, Galway University Hospital, Galway, Ireland
| | - Breda Flynn Murphy
- Speech and Language Therapy Department, Midland Regional Hospital Tullamore & Portlaoise, Offaly, Ireland
| | - Maria Cremin
- Speech and Language Therapy Department, University Hospital Kerry, Tralee, Ireland
| | - Denise Hilton
- Speech and Language Therapy Department, Cavan General Hospital, Cavan, Ireland
| | - Jenni Cavaliere
- Speech and Language Therapy Department, University Hospital Waterford, Waterford, Ireland
| | - Alice Whyte
- Speech and Language Therapy Department, Naas General Hospital, Naas, Ireland
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Osbeck Sandblom H, Dotevall H, Svennerholm K, Tuomi L, Finizia C. Characterization of dysphagia and laryngeal findings in COVID-19 patients treated in the ICU-An observational clinical study. PLoS One 2021; 16:e0252347. [PMID: 34086717 PMCID: PMC8177545 DOI: 10.1371/journal.pone.0252347] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/12/2021] [Indexed: 12/19/2022] Open
Abstract
Background Dysphagia appears to be common in patients with severe COVID-19. Information about the characteristics of dysphagia and laryngeal findings in COVID-19 patients treated in the intensive care unit (ICU) is still limited. Objectives The aim of this study was to evaluate oropharyngeal swallowing function and laryngeal appearance and function in patients with severe COVID-19. Method A series of 25 ICU patients with COVID-19 and signs of dysphagia were examined with fiberendoscopic evaluation of swallowing (FEES) during the latter stage of ICU care or after discharge from the ICU. Swallowing function and laryngeal findings were assessed with standard rating scales from video recordings. Results Pooling of secretions was found in 92% of patients. Eleven patients (44%) showed signs of silent aspiration to the trachea on at least one occasion. All patients showed residue after swallowing to some degree both in the vallecula and hypopharynx. Seventy-six percent of patients had impaired vocal cord movement. Erythema of the vocal folds was found in 60% of patients and edema in the arytenoid region in 60%. Conclusion Impairment of oropharyngeal swallowing function and abnormal laryngeal findings were common in this series of patients with severe COVID-19 treated in the ICU. To avoid complications related to dysphagia in this patient group, it seems to be of great importance to evaluate the swallowing function as a standard procedure, preferably at an early stage, before initiation of oral intake. Fiberendoscopic evaluation of swallowing is preferred due to the high incidence of pooling of secretion in the hypopharynx, silent aspiration, and residuals. Further studies of the impact on swallowing function in short- and long-term in patients with COVID-19 are warranted.
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Affiliation(s)
- Hanna Osbeck Sandblom
- Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Dotevall
- Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Svennerholm
- Department of Anaesthesiology and Intensive Care Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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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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Zanon A, Cacciaguerra L, Martelli G, Filippi M. Neurosensory dysphagia in a COVID-19 patient. J Neurol 2021; 268:3992-3994. [PMID: 33876325 PMCID: PMC8055053 DOI: 10.1007/s00415-021-10541-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Alessia Zanon
- Surgical Department, Otorhinolaryngology Unit, General Hospitals of Dolo and Mirano, Via Mariutto 76, 30035, Venice, Mirano, Italy.
| | - Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriele Martelli
- Intensive Care Unit "U.O.C. Anestesia E Rianimazione, Department of Surgery, Padua University Hospital, Padua, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, Milan, Italy
- Neurophysiology Unit, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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COVID-19 Infection-Related Weight Loss Decreases Eating/Swallowing Function in Schizophrenic Patients. Nutrients 2021; 13:nu13041113. [PMID: 33805263 PMCID: PMC8065805 DOI: 10.3390/nu13041113] [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] [Received: 01/30/2021] [Revised: 03/05/2021] [Accepted: 03/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background: In older people with psychoneurological diseases, COVID-19 infection may be associated with a risk of developing or exacerbating dysphagia. The aim of the present study was to examine the relationship between eating/swallowing function and COVID-19 infection. Methods: Subjects were 44 inpatients with confirmed COVID-19 infection being treated for schizophrenia in a psychiatric ward. Eating function was assessed using the Food Intake Level Scale (FILS) before and after infection. We also evaluated age, comorbidities, COVID-19 hospital stay, obesity index, weight loss rate, and chlorpromazine equivalent. Results: Subjects had a mean age of 68.86 years. Pre-infection, 20 subjects had a FILS score of 7–9 (presence of eating/swallowing disorder) and 24 subjects had a score of 10 (normal). Eating function after infection resolution showed decreasing FILS score compared to that before infection in 14 subjects (74.14 years). Six subjects (79.3 years) transitioned from oral feeding to parenteral feeding. A ≥ 10% weight loss during infection treatment was significantly associated with decreased eating function and a transition to parenteral feeding. Chlorpromazine equivalents, comorbidities, and number of days of hospitalization showed no associations with decreased eating function. Conclusions: Preventing malnutrition during treatment for COVID-19 infection is important for improving post-infection life prognosis and maintaining quality of life (QOL).
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Traugott M, Hoepler W, Kitzberger R, Pavlata S, Seitz T, Baumgartner S, Placher-Sorko G, Pirker-Krassnig D, Ehehalt U, Grasnek A, Beham-Kacerovsky M, Friese E, Wenisch C, Neuhold S. Successful treatment of intubation-induced severe neurogenic post-extubation dysphagia using pharyngeal electrical stimulation in a COVID-19 survivor: a case report. J Med Case Rep 2021; 15:148. [PMID: 33752743 PMCID: PMC7983095 DOI: 10.1186/s13256-021-02763-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/01/2021] [Indexed: 02/08/2023] Open
Abstract
Background A significant portion of critically ill patients with coronavirus disease 2019 (COVID-19) are at high risk of developing intensive care unit (ICU)-acquired swallowing dysfunction (neurogenic dysphagia) as a consequence of requiring prolonged mechanical ventilation. Pharyngeal electrical stimulation (PES) is a simple and safe treatment for neurogenic dysphagia. It has been shown that PES can restore safe swallowing in orally intubated or tracheotomized ICU patients with neurogenic dysphagia following severe stroke. We report the case of a patient with severe neurogenic post-extubation dysphagia (PED) due to prolonged intubation and severe general muscle weakness related to COVID-19, which was successfully treated using PES. Case presentation A 71-year-old Caucasian female patient with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection developed neurogenic dysphagia following prolonged intubation in the ICU. To avoid aerosol-generating procedures, her swallowing function was evaluated non-instrumentally as recommended by recently published international guidelines in response to the COVID-19 pandemic. Her swallowing function was markedly impaired and PES therapy was recommended. PES led to a rapid improvement of the PED, as evaluated by bedside swallowing assessments using the Gugging Swallowing Screen (GUSS) and Dysphagia Severity Rating Scale (DSRS), and diet screening using the Functional Oral Intake Scale (FOIS). The improved swallowing, as reflected by these measures, allowed this patient to transfer from the ICU to a non-intensive medical department 5 days after completing PES treatment. Conclusions PES treatment contributed to the restoration of a safe swallowing function in this critically ill patient with COVID-19 and ICU-acquired swallowing dysfunction. Early clinical bedside swallowing assessment and dysphagia intervention in COVID-19 patients is crucial to optimize their full recovery. PES may contribute to a safe and earlier ICU discharge of patients with ICU-acquired swallowing dysfunction. Earlier ICU discharge and reduced rates of re-intubation following PES can help alleviate some of the pressure on ICU bed capacity, which is critical in times of a health emergency such as the ongoing COVID-19 pandemic.
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Affiliation(s)
- Marianna Traugott
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.
| | - Wolfgang Hoepler
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Reinhard Kitzberger
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sophie Pavlata
- Otorhinolaryngeology Department, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Tamara Seitz
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sebastian Baumgartner
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Gudrun Placher-Sorko
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Daniela Pirker-Krassnig
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Urs Ehehalt
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Andreas Grasnek
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Michaela Beham-Kacerovsky
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Emanuela Friese
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Christoph Wenisch
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Stephanie Neuhold
- Fourth Medical Department with Infectious Diseases and Tropical Medicine, Klinik Favoriten - Kaiser Franz Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
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Bobkova NV. The Balance between Two Branches of RAS Can Protect from Severe COVID-19 Course. BIOCHEMISTRY (MOSCOW) SUPPLEMENT. SERIES A, MEMBRANE AND CELL BIOLOGY 2021; 15:36-51. [PMID: 33643542 PMCID: PMC7897458 DOI: 10.1134/s1990747821010037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/09/2020] [Accepted: 09/22/2020] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has swept the world and required the mobilization of scientists and clinicians around the world to combat this serious disease. Along with SARS-CoV-2 virology research, understanding of the fundamental physiological processes, molecular and cellular mechanisms and intracellular signaling pathways underlying the clinical manifestations of COVID-19 is important for effective therapy of this disease. The review describes in detail the interaction of the components of the renin-angiotensin system (RAS) and receptors of end-glycosylated products (RAGE), which plays a special role in normal lung physiology and in pathological conditions in COVID-19, including the development of acute respiratory distress syndrome and "cytokine storm". A separate section is devoted to the latest developments aimed at correcting the dysfunction of the RAS caused by the binding of the virus to angiotensin converting enzyme 2 (ACE2)- the central element of this system. Analysis of published theoretical, clinical, and experimental data indicates the need for a complex treatment to prevent a severe course of COVID-19 using MasR agonists, blockers of the AT1R and NF-κB signaling pathway, as well as compounds with neuroprotective and neuroregenerative effects.
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Affiliation(s)
- N. V. Bobkova
- Institute of Cell Biophysics, Federal Research Center “Pushchino Scientific Center for Biological Research of the Russian Academy of Sciences”, 142290 Pushchino, Moscow oblast Russia
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Swallowing and Voice Outcomes in Patients Hospitalized With COVID-19: An Observational Cohort Study. Arch Phys Med Rehabil 2021; 102:1084-1090. [PMID: 33529610 PMCID: PMC7846878 DOI: 10.1016/j.apmr.2021.01.063] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/31/2022]
Abstract
Objective To evaluate the presentations and outcomes of inpatients with coronavirus disease 2019 (COVID-19) presenting with dysphonia and dysphagia to investigate trends and inform potential pathways for ongoing care. Design Observational cohort study. Setting An inner-city National Health Service Hospital Trust in London, United Kingdom. Participants All adult inpatients hospitalized with COVID-19 (N=164) who were referred to Speech and Language Therapy (SLT) for voice and/or swallowing assessment for 2 months starting in April 2020. Interventions SLT assessment, advice, and therapy for dysphonia and dysphagia. Main Outcome Measures Evidence of delirium, neurologic presentation, intubation, tracheostomy, and proning history were collected, along with type of SLT provided and discharge outcomes. Therapy outcome measures were recorded for swallowing and tracheostomy pre- and post-SLT intervention and Grade Roughness Breathiness Asthenia Strain Scale for voice. Results Patients (N=164; 104 men) aged 56.8±16.7 years were included. Half (52.4%) had a tracheostomy, 78.7% had been intubated (mean, 15±6.6d), 13.4% had new neurologic impairment, and 69.5% were delirious. Individualized compensatory strategies were trialed in all and direct exercises with 11%. Baseline assessments showed marked impairments in dysphagia and voice, but there was significant improvement in all during the study (P<.0001). On average, patients started some oral intake 2 days after initial SLT assessment (interquartile range [IQR], 0-8) and were eating and drinking normally on discharge, but 29.3% (n=29) of those with dysphagia and 56.1% (n=37) of those with dysphonia remained impaired at hospital discharge. A total of 70.9% tracheostomized patients were decannulated, and the median time to decannulation was 19 days (IQR, 16-27). Among the 164 patients, 37.3% completed SLT input while inpatients, 23.5% were transferred to another hospital, 17.1% had voice, and 7.8% required community follow-up for dysphagia. Conclusions Inpatients with COVID-19 present with significant impairments of voice and swallowing, justifying responsive SLT. Prolonged intubations and tracheostomies were the norm, and a minority had new neurologic presentations. Patients typically improved with assessment that enabled treatment with individualized compensatory strategies. Services preparing for COVID-19 should target resources for tracheostomy weaning and to enable responsive management of dysphagia and dysphonia with robust referral pathways.
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Abstract
Importance: Dysphagia is a common complication of critical illness, and many known risk factors are also present in critically ill coronavirus disease 2019 victims. Objectives: To investigate dysphagia in patients with severe coronavirus disease 2019. Design, Setting, and Participants: In this case series, we report results of dedicated evaluation of swallowing function in six consecutive, tracheotomized coronavirus disease 2019 patients after they had survived acute respiratory distress syndrome and were weaned from the respirator. Main Outcomes and Measures: Dysphagia was assessed with flexible endoscopic evaluation of swallowing. Results: Three patients suffered from severe dysphagia and airway compromise precluding decannulation, whereas in the other, three swallowing was less critically impaired, and the tracheal cannula could be removed. Four patients presented with additional laryngeal dysfunctions not typically seen in acute respiratory distress syndrome survivors. Conclusion and Relevance: Dysphagia with impaired airway protection is a key feature in coronavirus disease 2019 acute respiratory distress syndrome survivors. Apart from critical illness polyneuropathy, coronavirus disease 2019–related involvement of the peripheral and central nervous system may contribute to swallowing impairment and laryngeal dysfunction.
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Lagier A, Melotte E, Poncelet M, Remacle S, Meunier P. Swallowing function after severe COVID-19: early videofluoroscopic findings. Eur Arch Otorhinolaryngol 2021; 278:3119-3123. [PMID: 33388981 PMCID: PMC7778703 DOI: 10.1007/s00405-020-06522-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/26/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The aim of this paper is to describe the early findings of swallowing analysis with videofluoroscopy of swallowing (VFS). METHODS The 21 first patients (14 men and 7 women) who recovered from ARDS in context of COVID-19 were referred to VFS just before to maximum 14 days after their discharge from ICU. The swallowing impairments and the physiopathologic mechanism of them were prospectively analyzed by two swallowing experts: one radiologist, and one phoniatrician using penetration-aspiration scale (PAS) score. RESULTS Nineteen out of 21 presented impairment in their swallowing function. Sixteen patients presented direct penetration or inhalation. All but one were silent. Some stases were also observed in 13 patients. Five patients presented secondary penetration/aspiration, among these inhalations, and all were silent. The most frequent findings are the delayed pharyngeal phase, the reduced propulsion of the tongue root, the posterior oral leaks, the default of laryngeal closure, and the impaired pharyngeal peristaltism. DISCUSSION The very high prevalence of swallowing disorders with inhalation and the lack of protective reflexes are the main findings. This emphasizes the need of high caution with bedside screening in these patients with severely injured lungs.
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Affiliation(s)
- Aude Lagier
- Service D'ORL, CHU de Liège, Avenue de l'hôpital, 1, 4000, Liège, Belgium.
| | - Evelyne Melotte
- Service de Médecine Physique Et Réadaptation, CHU de Liège, Liège, Belgium
| | | | - Sarah Remacle
- Service D'ORL, CHU de Liège, Avenue de l'hôpital, 1, 4000, Liège, Belgium
| | - Paul Meunier
- Service de Radiologie, CHU de Liège, Liège, Belgium
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Pfortmueller CA, Spinetti T, Urman RD, Luedi MM, Schefold JC. COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment - A narrative review. Best Pract Res Clin Anaesthesiol 2020; 35:351-368. [PMID: 34511224 PMCID: PMC7831801 DOI: 10.1016/j.bpa.2020.12.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces coronavirus-19 disease (COVID-19) and is a major health concern. Following two SARS-CoV-2 pandemic “waves,” intensive care unit (ICU) specialists are treating a large number of COVID19-associated acute respiratory distress syndrome (ARDS) patients. From a pathophysiological perspective, prominent mechanisms of COVID19-associated ARDS (CARDS) include severe pulmonary infiltration/edema and inflammation leading to impaired alveolar homeostasis, alteration of pulmonary physiology resulting in pulmonary fibrosis, endothelial inflammation (endotheliitis), vascular thrombosis, and immune cell activation. Although the syndrome ARDS serves as an umbrella term, distinct, i.e., CARDS-specific pathomechanisms and comorbidities can be noted (e.g., virus-induced endotheliitis associated with thromboembolism) and some aspects of CARDS can be considered ARDS “atypical.” Importantly, specific evidence-based medical interventions for CARDS (with the potential exception of corticosteroid use) are currently unavailable, limiting treatment efforts to mostly supportive ICU care. In this article, we will discuss the underlying pulmonary pathophysiology and the clinical management of CARDS. In addition, we will outline current and potential future treatment approaches.
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Affiliation(s)
- Carmen A Pfortmueller
- Department of Intensive Care Medicine, Inselspital, Bern, University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Thibaud Spinetti
- Department of Intensive Care Medicine, Inselspital, Bern, University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern, University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern, University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
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Jakubiak GK, Ochab-Jakubiak J, Cieślar G, Stanek A. Gastrointestinal symptoms in the course
of COVID-19. POSTEP HIG MED DOSW 2020; 74:498-503. [DOI: 10.5604/01.3001.0014.5459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2024] Open
Abstract
COVID-19 is an infectious disease caused by novel coronavirus SARS-CoV-2, a betacoronavirus
comprised of single-stranded ribonucleic acid (RNA), the first time reported in December
2019 as pneumonia with unknown etiology in Wuhan City in China. It is a very important
current problem for public health worldwide. A typical clinical course includes dyspnoea,
dry cough and fever. In the presented paper we conducted the literature review and described
the most important facts within the current state of knowledge about symptomatology
and pathophysiology of gastrointestinal dysfunction in the course of COVID-19. Data about
prevalence of gastrointestinal symptoms in the course of COVID-19 show wide divergence in
the cited literature. Generally, the most common reported digestive symptoms were loss of
appetite, nausea and vomiting. Liver injury in the course of COVID-19 is also an important
and not well understood problem. The virus has high affinity to cells containing angiotensin-
-converting enzyme 2 (ACE2) protein. Digestive symptoms of COVID-19 may be associated with
ACE2 expression in epithelial cells in upper oesophagus, ileum and colon. Previous scientific
reports have elucidated the role of ACE2 in modulating intestinal inflammation and diarrhoea.
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Affiliation(s)
- Grzegorz K. Jakubiak
- Specialistic Hospital No. 2 in Bytom, Department and Clinic of Internal Medicine, Angiology and Physical Medicine, Bytom, Poland
| | - Józefina Ochab-Jakubiak
- Specialistic Hospital No. 2 in Bytom, Department and Clinic of Internal Medicine, Angiology and Physical Medicine, Bytom, Poland
| | - Grzegorz Cieślar
- Medical University of Silesia, Faculty of Medical Sciences in Zabrze, Department of Internal Medicine, Angiology and Physical Medicine, Bytom, Poland
| | - Agata Stanek
- Medical University of Silesia, Faculty of Medical Sciences in Zabrze, Department of Internal Medicine, Angiology and Physical Medicine, Bytom, Poland
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Nie L, Dai K, Wu J, Zhou X, Hu J, Zhang C, Zhan Y, Song Y, Fan W, Hu Z, Yang H, Yang Q, Wu D, Li F, Li D, Nie R. Clinical characteristics and risk factors for in-hospital mortality of lung cancer patients with COVID-19: A multicenter, retrospective, cohort study. Thorac Cancer 2020; 12:57-65. [PMID: 33142039 PMCID: PMC7779192 DOI: 10.1111/1759-7714.13710] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/02/2020] [Accepted: 10/03/2020] [Indexed: 12/28/2022] Open
Abstract
Background Data on clinical, laboratory, and radiographic characteristics and risk factors for in‐hospital mortality of lung cancer patients with COVID‐19 are scarce. Here, we aimed to characterize the early clinical features of lung cancer patients with COVID‐19 and identify risk factors associated with in‐hospital mortality. Methods All consecutive lung cancer patients with laboratory‐confirmed COVID‐19 admitted to 12 hospitals in Hubei province, China, from 3 January to 6 May 2020 were included in the study. Patients without definite clinical outcomes during the period were excluded. Data on initial clinical, laboratory and radiographic findings were compared between survivors and nonsurvivors. Univariable and multivariable logistic regression analyses were used to explore the risk factors associated with in‐hospital mortality. Results Of the 45 lung cancer patients (median [interquartile range] age, 66 [58–74] years; 68.9% males) included, 34 (75.6%) discharged and 11 (24.4%) died. Fever (73.3%) and cough (53.3%) were the dominant initial symptoms, and respiratory symptoms were common. Lung cancer patients also presented atypical appearances of COVID‐19. In the multivariable analysis, prolonged prolongation prothrombin time (PT) (OR = 2.1, 95% CI: 1.00–4.41, P = 0.0497) and elevated high sensitivity cardiac troponin I (hs‐TNI) (OR = 7.65, 95% CI: 1.24–47.39, P = 0.0287) were associated with an increased risk of in‐hospital mortality. Conclusions Lung cancer patients with COVID‐19 have high in‐hospital mortality. Prolonged PT and elevated hs‐TNI are independent risk factors for in‐hospital mortality of lung cancer patients with COVID‐19. Key points Significant findings of the study Lung cancer patients with COVID‐19 have atypical early symptoms and imaging features. The prolonged prothrombin time and elevated high sensitivity cardiac troponin I are independent risk factors for in‐hospital mortality of lung cancer patients with COVID‐19.
What this study adds This study characterizes the early clinical features of lung cancer patients with COVID‐19 in China, and identifies the risk factors associated with in‐hospital mortality of lung cancer patients with COVID‐19.
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Affiliation(s)
- Lei Nie
- Department of Hepatobiliary and Pancreatic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Dai
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiang Wu
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xia Zhou
- Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, China
| | - Junjun Hu
- Department of Surgery, Wuhan NO. 7 Hospital, Wuhan, China
| | - Chao Zhang
- Department of Hepatobiliary Surgery, Wuhan NO.1 hospital, Wuhan, China
| | - Yan Zhan
- Department of rehabilitation medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Yu Song
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Wuhan, China
| | - Wen Fan
- Department of General Medicine, The First People's Hospital of Jingzhou Affiliated No. 1 Hospital of Changjiang University, Jingzhou, China
| | - Zhimin Hu
- Endoscopy Center, Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, China
| | - Hongshan Yang
- Department of Medical Oncology, Affiliated Xiaogan Hospital of Wuhan University of Science and Technology, Xiaogan, China
| | - Qiong Yang
- Department of Obstetrics, Hubei Maternal and Child Health Hospital, Wuhan, China
| | - Dongde Wu
- Department of Hepatobiliary and Pancreatic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fajiu Li
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Daoyuan Li
- Department of Art and Design, Hubei University of Technology Engineering and Technology College, Wuhan, China
| | - Rui Nie
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Bath PM, Woodhouse LJ, Suntrup-Krueger S, Likar R, Koestenberger M, Warusevitane A, Herzog J, Schuttler M, Ragab S, Everton L, Ledl C, Walther E, Saltuari L, Pucks-Faes E, Bocksrucker C, Vosko M, de Broux J, Haase CG, Raginis-Zborowska A, Mistry S, Hamdy S, Dziewas R. Pharyngeal electrical stimulation for neurogenic dysphagia following stroke, traumatic brain injury or other causes: Main results from the PHADER cohort study. EClinicalMedicine 2020; 28:100608. [PMID: 33294818 PMCID: PMC7700977 DOI: 10.1016/j.eclinm.2020.100608] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Neurogenic dysphagia is common and has no definitive treatment. We assessed whether pharyngeal electrical stimulation (PES) is associated with reduced dysphagia. METHODS The PHAryngeal electrical stimulation for treatment of neurogenic Dysphagia European Registry (PHADER) was a prospective single-arm observational cohort study. Participants were recruited with neurogenic dysphagia (comprising five groups - stroke not needing ventilation; stroke needing ventilation; ventilation acquired; traumatic brain injury; other neurological causes). PES was administered once daily for three days. The primary outcome was the validated dysphagia severity rating scale (DSRS, score best-worst 0-12) at 3 months. FINDINGS Of 255 enrolled patients from 14 centres in Austria, Germany and UK, 10 failed screening. At baseline, mean (standard deviation) or median [interquartile range]: age 68 (14) years, male 71%, DSRS 11·4 (1·7), time from onset to treatment 32 [44] days; age, time and DSRS differed between diagnostic groups. Insertion of PES catheters was successfully inserted in 239/245 (98%) participants, and was typically easy taking 11·8 min. 9 participants withdrew before the end of treatment. DSRS improved significantly in all dysphagia groups, difference in means (95% confidence intervals, CI) from 0 to 3 months: stroke (n = 79) -6·7 (-7·8, -5·5), ventilated stroke (n = 98) -6·5 (-7·6, -5·5); ventilation acquired (n = 35) -6·6 (-8·4, -4·8); traumatic brain injury (n = 24) -4·5 (-6·6, -2·4). The results for DSRS were mirrored for instrumentally assessed penetration aspiration scale scores. DSRS improved in both supratentorial and infratentorial stroke, with no difference between them (p = 0·32). In previously ventilated participants with tracheotomy, DSRS improved more in participants who could be decannulated (n = 66) -7·5 (-8·6, -6·5) versus not decannulated (n = 33) -2·1 (-3·2, -1·0) (p<0·001). 74 serious adverse events (SAE) occurred in 60 participants with pneumonia (9·2%) the most frequent SAE. INTERPRETATION In patients with neurogenic dysphagia, PES was safe and associated with reduced measures of dysphagia and penetration/aspiration. FUNDING Phagenesis Ltd.
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Affiliation(s)
- Philip M. Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham NG5 1PB, United Kingdom
- Stroke, Nottingham University Hospital NHS Trust, Nottingham NG5 1PB, United Kingdom
- Corresponding author at: Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham NG5 1PB, United Kingdom.
| | - Lisa J. Woodhouse
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham NG5 1PB, United Kingdom
| | - Sonja Suntrup-Krueger
- Department of Neurology, University Hospital Münster, Building A1, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Rudolf Likar
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
| | - Markus Koestenberger
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
| | - Anushka Warusevitane
- Stroke Research, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Parish Building, 1st Floor, Newcastle Road, Stoke-on-Trent, Staffordshire ST4 6QG, United Kingdom
| | - Juergen Herzog
- Clinic for Neurological Rehabilitation and Early Rehabilitation, Schön Klinik München-Schwabing, Parzivalplatz 4, 80804 Munich, Germany
| | - Michael Schuttler
- Centre of Neurology, Schön Klinik Bad Staffelstein, Am Kurpark 11, 96231 Bad Staffelstein, Germany
| | - Suzanne Ragab
- Department of Stroke, Philip Arnold Unit Ground Floor, Poole Hospital NHS Foundation Trust, Longfleet road, Poole BH15 2JB, United Kingdom
| | - Lisa Everton
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham NG5 1PB, United Kingdom
- Speech and Language Therapy, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham NG3 6AA, United Kingdom
| | - Christian Ledl
- Specialist Clinic for Neurology, Neurological Rehabilitation and Alzheimer's Therapy, Schön Klinik Bad Aibling, Kolbermoorer Strasse 72, 83043 Bad Aibling, Germany
| | - Ernst Walther
- Clinic for Neurology and Neurorehabilitation, Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Leopold Saltuari
- Department of Neurology, Ö. Landeskrankenhaus Hochzirl-Natters, Tiroler landesrankenanstalten GmbH. LkH Hochzirl, 6170 Zirl/Hochzirl, Austria
| | - Elke Pucks-Faes
- Department of Neurology, Ö. Landeskrankenhaus Hochzirl-Natters, Tiroler landesrankenanstalten GmbH. LkH Hochzirl, 6170 Zirl/Hochzirl, Austria
| | - Christof Bocksrucker
- Department of Neurology, Konventhospital Barmherzige Brúder Linz, Seilerstätte 2, 4021 Linz, Austria
| | - Milan Vosko
- Department of Neurology 2, Kepler Universitätsklinikum, Med Campus III, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Johanna de Broux
- Clinic for Neurology, Alexianer Krefeld GmbH, Dießemer Bruch 81, 47805 Krefeld, Germany
| | - Claus G. Haase
- Clinic for Neurology and Neurophysiology, Evangelische Kliniken Gelsenkirchen, Lehrkrankenhaus der Universität Essen-Duisburg, Munckelstr. 27, 45879 Gelsenkirchen, Germany
| | | | - Satish Mistry
- Department for Clinical Research, Phagenesis Limited, Manchester M15 6SE, United Kingdom
| | - Shaheen Hamdy
- Department for Clinical Research, Phagenesis Limited, Manchester M15 6SE, United Kingdom
- Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester M6 8HD, United Kingdom
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Building A1, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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Torretta S, Gaini LM, Gaffuri M, Pignataro L, Accorona R, Capaccio P. Looking at the day after COVID-19… what laryngeal sequelae should we expect? ACTA OTORHINOLARYNGOLOGICA ITALICA 2020; 40:466-468. [PMID: 32970048 PMCID: PMC7889259 DOI: 10.14639/0392-100x-n0884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/09/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Sara Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, Department of Clinical Sciences and Community Health, Milan, Italy
| | | | - Michele Gaffuri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Remo Accorona
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pasquale Capaccio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università degli Studi di Milano, Department of Biomedical Surgical Dental Science, Milan, Italy
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Fong R, Tsai KCF, Tong MCF, Lee KYS. Management of Dysphagia in Nursing Homes During the COVID-19 Pandemic: Strategies and Experiences. ACTA ACUST UNITED AC 2020; 2:1361-1365. [PMID: 32838197 PMCID: PMC7433678 DOI: 10.1007/s42399-020-00464-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 12/05/2022]
Abstract
The global 2019 novel coronavirus disease (COVID-19) pandemic has had devastating effects not only on healthcare systems worldwide but also on different aspects of the care provided to nursing home residents. Dysphagia management is a crucial component of the care provided to many nursing home residents. This article presents the dysphagia management strategies applied in Hong Kong during the COVID-19 pandemic and the related experiences. A two-tier protection system was implemented wherein residents were categorised according to their contact and hospitalisation histories. The provided swallowing management and personal protective equipment level differed between the two tiers. The article also discusses the referral and prioritisation of clinical services for residents requiring swallowing management, as well as the adaptations of swallowing assessment and management during the pandemic. The possible effects of COVID-19 on mealtime arrangements in nursing homes, the implications of the pandemic on the use of personal protective equipment and the use of telepractice in nursing homes were also discussed. This article has summarised the actions taken in this regard and may serve as a reference to clinicians who are responsible for swallowing assessments and dysphagia management in nursing homes.
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Affiliation(s)
- Raymond Fong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Michael C. F. Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Kathy Y. S. Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
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