Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study

Dysphagia - Tập 38 Số 2 - Trang 657-666 - 2023
Camilla Dawson1, Paul Nankivell2, J.P. Pracy3, R Capewell1, Martin Wood1, Jonathan Weblin1, Dhruv Parekh4, Jaimin Patel5, Stacey A. Skoretz6, Naveen Sharma3
1Department of Therapy Services, Queen Elizabeth Hospital Birmingham NHSFT, Birmingham, UK
2Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
3Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UK
4Centre for Translational Inflammation and Fibrosis Research, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
5Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, UK
6School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada

Tóm tắt

AbstractTo explore laryngeal function of tracheostomised patients with COVID-19 in the acute phase, to identify ways teams may facilitate and expedite tracheostomy weaning and rehabilitation of upper airway function. Consecutive tracheostomised patients underwent laryngeal examination during mechanical ventilation weaning. Primary outcomes included prevalence of upper aerodigestive oedema and airway protection during swallow, tracheostomy duration, ICU frailty scores, and oral intake type. Analyses included bivariate associations and exploratory multivariable regressions. 48 consecutive patients who underwent tracheostomy insertion as part of their respiratory wean following invasive ventilation in a single UK tertiary hospital were included. 21 (43.8%) had impaired airway protection on swallow (PAS ≥ 3) with 32 (66.7%) having marked airway oedema in at least one laryngeal area. Impaired airway protection was associated with longer total artificial airway duration (p = 0.008), longer tracheostomy tube duration (p = 0.007), multiple intubations (p = 0.006) and was associated with persistent ICU acquired weakness at ICU discharge (p = 0.03). Impaired airway protection was also an independent predictor for longer tracheostomy tube duration (p = 0.02, Beta 0.38, 95% CI 2.36 to 27.16). The majority of our study patients presented with complex laryngeal findings which were associated with impaired airway protection. We suggest a proactive standardized scoring and review protocol to manage this complex group of patients in order to maximize health outcomes and ICU resources. Early laryngeal assessment may facilitate weaning from invasive mechanical ventilation and liberation from tracheostomy, as well as practical and objective risk stratification for patients regarding decannulation and feeding.

Từ khóa


Tài liệu tham khảo

ICNAaR (2021) Intensive Care National Audit and Research Centre ICNARC report on COVID-19 in critical care

Queen Elizabeth Hospital Birmingham Covid-19 airway team. Safety and 30-day outcomes of tracheostomy for COVID-19: a prospective observational cohort study. Br J Anaesth. 2020;125(6):872–9.

Santus P, Gramegna A, Radovanovic D, Raccanelli R, Valenti V, Rabbiosi D, Vitacca M, Nava S. A systematic review on tracheostomy decannulation: a proposal of a quantitative semiquantitative clinical score. BMC Pulm Med. 2014;14(1):201.

Freeman-Sanderson AL, Togher L, Elkins MR, Phipps PR. Return of voice for ventilated tracheostomy patients in ICU: a randomized controlled trial of early-targeted intervention. Crit Care Med. 2016;44(6):1075–81.

Zazzara MB, Penfold RS, Roberts AL, Lee KA, Dooley H, Sudre CH, Welch C, Bowyer RCE, Visconti A, Mangino M, et al. Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults. Age Ageing. 2020;50(1):40–8.

Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LFP. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol. 2020;20(6):363–74.

Dhont S, Derom E, Van Braeckel E, Depuydt P, Lambrecht BN. The pathophysiology of ‘happy’ hypoxemia in COVID-19. Respir Res. 2020;21(1):198.

Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7(6):e438–40.

Dawson C, Capewell R, Ellis S, Matthews S, Adamson S, Wood M, Fitch L, Reid K, Shaw M, Wheeler J, et al. Dysphagia presentation and management following COVID-19: an acute care tertiary centre experience. J Laryngol Otol. 2020. https://doi.org/10.1017/S0022215120002443.

McWilliams D, Weblin J, Hodson J, Veenith T, Whitehouse T, Snelson C. Rehabilitation levels in patients with COVID-19 admitted to intensive care requiring invasive ventilation. An observational study. Ann Am Thorac Soc. 2020;18(1):122–9.

McGrath BA, Wallace S, Goswamy J. Laryngeal oedema associated with COVID-19 complicating airway management. Anaesthesia. 2020;75(7):972–972.

Starmer HM, Drinnan M, Bhabra M, Watson LJ, Patterson J. Development and reliability of the revised Patterson Edema Scale. Clin Otolaryngol. 2021;46(4):752–7.

Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8.

Hermans G, Clerckx B, Vanhullebusch T, Segers J, Vanpee G, Robbeets C, Casaer MP, Wouters P, Gosselink R, Van Den Berghe G. Interobserver agreement of Medical Research Council sum-score and handgrip strength in the intensive care unit. Muscle Nerve. 2012;45(1):18–25.

Mcwilliams D, Atkins G, Hodson J, Boyers M, Lea T, Snelson C. Is the manchester mobility score a valid and reliable measure of physical function within the intensive care unit. Intensive Care Med Exp. 2015;3(1):1–2.

Menard S. Logistic regression diagnostics and problems of inference. In: Menard S, editor. Logistic regression From introductory to advanced concepts and applications. SAGE: Thousand Oaks; 2010. p. 125–45.

Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007;165(6):710–8.

Kwak PE, Connors JR, Benedict PA, Timen MR, Wang B, Zhang Y, Youlios S, Sureau K, Persky MJ, Rafeq S, et al. Early outcomes from early tracheostomy for patients with COVID-19. JAMA Otolaryngol Head Neck Surg. 2021;147(3):239–44.

Hernandez G, Ramos FJ, Añon JM, Ortiz R, Colinas L, Masclans JR, De Haro C, Ortega A, Peñuelas O, Cruz-Delgado MM, et al. Early tracheostomy for managing ICU capacity during the COVID-19 outbreak: a propensity-matched cohort study. Chest. 2021;161(1):121–9.

El-Anwar MW, Elzayat S, Fouad YA. ENT manifestation in COVID-19 patients. Auris Nasus Larynx. 2020;47(4):559–64.

Brodsky MB, Levy MJ, Jedlanek E, Pandian V, Blackford B, Price C, Cole G, Hillel AT, Best SR, Akst LM. Laryngeal injury and upper airway symptoms after oral endotracheal intubation with mechanical ventilation during critical care: a systematic review. Crit Care Med. 2018;46(12):2010–7.

Macht M, Wimbish T, Clark BJ, Benson AB, Burnham EL, Williams A, Moss M. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit Care. 2011;15(5):R231.

Hermans G, Van den Berghe G. Clinical review: intensive care unit acquired weakness. Crit Care. 2015;19(1):274.

McWilliams D, Jones C, Atkins G, Hodson J, Whitehouse T, Veenith T, Reeves E, Cooper L, Snelson C. Earlier and enhanced rehabilitation of mechanically ventilated patients in critical care: a feasibility randomised controlled trial. J Crit Care. 2018;44:407–12.

Skoretz SA, Riopelle SJ, Wellman L, Dawson C. Investigating swallowing and tracheostomy following critical illness: a scoping review. Crit Care Med. 2020;48(2):e141–51.

Nepogodiev D, Bhangu A, Glasbey JC, Li E, Omar OM, Simoes JF, Abbott TE, Alser O, Arnaud AP, Bankhead-Kendall BK. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. The Lancet. 2020;396(10243):27–38.

Thông tin
Thông tin xuất bản

Dysphagia

Tập 38 Số 2

657-666

Thông tin tác giả