key: cord-0737475-bxbo2dkl authors: Glotta, A.; Galli, A.; Biggiogero, M.; Bona, G.; Saporito, A.; Mauri, R.; Ceruti, S. title: Dysphagic disorder in a cohort of COVID-19 patients: evaluation and evolution date: 2021-06-22 journal: nan DOI: 10.1101/2021.06.20.21258947 sha: 52c490a7fbf2b526f6cf28e7d5c36e4ad2881f8a doc_id: 737475 cord_uid: bxbo2dkl Background: COVID-19 is a multisystem disease complicated by respiratory failure requiring sustanined mechanical ventilation (MV). Prolongued oro-tracheal intubation is associated to an increased risk of dysphagia and bronchial aspiration. Purpose of this study was to investigate swallowing disorders in critically ill COVID-19 patients. Methods This was a retrospective study analysing a consecutive cohort of COVID-19 patients admitted to the Intensive Care Unit (ICU) of our Hospital. Data concerning dysphagia were collected according to the Gugging Swallowing Screen (GUSS) and related to demographic characteristics, clinical data, ICU Length-Of-Stay (LOS) and MV parameters. Results From March 2 to April 30 2020, 31 consecutive critically ill COVID-19 patients admitted to ICU were evaluated by speech and language therapists (SLT). Twenty-five of them were on MV (61% through endotracheal tube and 19% through tracheostomy); median MV lenght was 11 days. Seventeen (54.8%) patients presented dysphagia; a correlation was found between first GUSS severity stratification and MV days (p < 0.001), ICU LOS (p < 0.001), age (p = 0.03) and tracheostomy (p = 0.042). No other correlations were found. At 16 days, 90% of patients had fully recovered; a significant improvement was registered especially during the first week (p < 0.001). Conclusion Compared to non-COVID-19 patiens, a higher rate of dysphagia was reported in COVID-19 patients, with a more rapid and complete recovery. A systematic early SLT evaluation of COVID-19 patients on MV may thus be useful to prevent dysphagia-related complications. The Canton Ticino was one of the Swiss Regions worstly affected by the COVID-19 pandemic 16 ; more than 1613 patients were admitted at our Hospital for this disease and more than 100 patients were admitted to the ICU. We conducted a retrospective observational study on a consecutive cohort of patients affected by COVID-19 requiring MV, admitted to our ICU since March 2 nd to April 30 th 2020. After local Ethical Committee approval (Comitato Etico Cantonale, ref. n. CE_TI_3692), written informed consents from each patient have been obtained before data collection. All patients were systematically evaluated by the speech and language therapists (SLT) team. Patients who died before the first evaluation and patients not on MV were excluded from the analysis. All collected data were reported on an electronic database. In order to minimize the risk of contagion, SLT evaluations consisted of a clinical evaluation only. Among different options availale to assess and quantify dysphagia, like the Toronto bedside swallowing screen test The evaluation was completed following the Logemann protocol procedures 23 . Based on the global evaluation (GUSS and Logemann protocol procedure), a rehabilitation programme was structured. Its aims were to reduce the oral and pharyngeal sensitivity deficit, the delay of swallowing reflex start 21,24-26 , and the glottic closure deficit 27 as well as to improve laryngeal elevation motor skills 28, 29 . For each patient, SLT assessments were performed at day 0, day 7, day 14, day 21 and day 28, both in ICU and after transfer to the Internal Medicine ward. Additional demographic factors like age, body-mass index (BMI) and comorbidities like chronic-obstructive pulmonary disease (COPD), obstructive sleep apnea syndrome, diabetes, hypertension and ischemic heart disease (IHD) were registered and reported. Evaluation of ICU severity scores NEMS (nine equivalents of nursing manpower use score), SAPS (simplified acute physiology score) and SOFA (sequential organ failure assessment) at ICU admission were calculated for every patient included.MV parameters, days of MV, ICU LOS, number of pronation manouvers performed and positive end-expiratory pressure (PEEP) values were also recorded for all cases. Finally, complications like ventilation-associated pneumonia (VAP), the need of continuous renal replacement therapy (CRRT) and venous-thromboembolism (VTE) were also registered and analyzed. Descriptive statistics of frequency was performed. Data were reported as number (percentage). Data distribution was reported as mean (SD) if normally distributed, otherwise as median (IQR). Data distribution was verified by Kolmogorov-Smirnov test. The relationship between GUSS values and continuous variables was analized by linear regression. Differences between continuous variables were studied by t-test; categorical data differences were carried out by Chi-square analysis. All statistical tests were two-tailed; significance level was established to be < 0.05. Statistical data analysis was performed using the SPSS 26.0 package (SPSS Inc, USA). All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. During the study period, 42 consecutive critically ill COVID-19 patients were admitted to our ICU; 11 of them died and were consequently excluded from the study. Thirty-one patients were systematically evaluated by the SLT team. Mean age was 61 years (SD 12 yrs) and 25 patients (80.6%) were male, with a mean BMI of 29 Kg/m 2 (SD 4.8). At admission, median NEMS score was 34 (18 -39) , mean SAPS score was 43 (SD 18) and mean SOFA score 6 (SD 2.8) (Table 1) . Of the 31 evaluated patients, 25 (80.64%) were on invasive MV; 19 (76%) were ventilated via an endotracheal tube and 6 (24%) underwent tracheostomy at some point, due to a prolonged MV. Median ICU LOS was 13 days (9-11) and median MV days were 11 (7.5-16). Patients ventilated via an endotracheal tube presented a mean MV days of 11.5 (SD 7.7) while patients undergoing tracheostomy presented a mean MV days of 20.5 (SD 11.6). In order to verify if tracheostomy has been determined by the previous MV days, a two-tailed T-test has been performed. No significant difference was found between MV days in patients ventilated via an endotracheal tube and MV days in patients ventilated via tracheostomy (t-test 1.780, p = Demographic characteristics at ICU admission. Data are presented as means (min-max, SD) or medians (IQR) for non-normally distributed variables. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Fig. 1 Linear regression between first SLT evaluation (day 0) and of MV days (r 2 = 0.616). Temporal evolution of dysphagia according to GUSS value, stratified into four semi-quantitative groups at different evaluation timepoints. GUSS evolution between day 0 and 7 and between day 7 and 14 were statistically significant (p < 0.0001 and p = 0.01 respectively). All rights reserved. No reuse allowed without permission. 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(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted