From the Guidelines
COVID-19 can cause dysphagia (difficulty swallowing) in approximately 52% of patients, particularly those with post-extubation dysphagia, and management requires a multidisciplinary approach. The relationship between COVID-19 and dysphagia is complex, involving multiple mechanisms such as direct viral damage to cranial nerves, post-intubation trauma, critical illness myopathy, and neurological complications 1. Initial assessment by a speech-language pathologist is essential to determine the severity and specific swallowing deficits.
Key Considerations
- Treatment typically includes swallowing exercises (such as the Mendelsohn maneuver, effortful swallow, and Shaker exercise), performed 5-10 repetitions, 3-5 times daily.
- Dietary modifications are often necessary, with progression from thickened liquids (nectar or honey consistency) to regular textures as tolerated.
- Postural techniques like chin tuck or head turn may help improve swallowing safety.
- For severe cases, temporary alternative feeding methods such as nasogastric tubes may be required.
- Medications aren't typically first-line treatment, though some patients might benefit from metoclopramide 5-10mg before meals to improve gastric emptying if gastroparesis is present, as suggested by studies on gastrointestinal symptoms in COVID-19 patients 1.
Recovery and Outcomes
Recovery time varies significantly, from weeks to months, with most improvement occurring within the first 3-6 months. Early intervention is crucial as dysphagia can lead to aspiration pneumonia, malnutrition, and dehydration, particularly in patients who required prolonged intubation during COVID treatment. The importance of nutritional support and management in patients with COVID-19, including those with dysphagia, is highlighted in recent studies 1, emphasizing the need for individualized care plans and multidisciplinary team approaches to optimize recovery and minimize complications.
From the Research
Relationship Between COVID-19 and Dysphagia
The relationship between COVID-19 and dysphagia is complex, with several studies indicating a high incidence of dysphagia in patients with COVID-19 2, 3, 4, 5, 6.
- Dysphagia is a key concern in critical illness survivors, and COVID-19 patients present a high incidence of dysphagia, aggravated by respiratory distress, deconditioning, and neurological complications 2.
- The majority of patients regain near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status 3.
- Dysphagia can occur even in non-intubated patients, and clinicians should be aware of this potential complication, especially in older adults with malnutrition or sarcopenia 4, 5.
Prevalence of Dysphagia in COVID-19 Patients
- A study found that 28.9% of patients admitted to a hospital with COVID-19 were referred for swallow assessment, and the majority of patients regained near normal swallow function prior to discharge 3.
- Another study found that 20% of non-intubated patients with COVID-19 presented with dysphagia symptoms, and 25% of these patients still presented with swallowing disorders after 6 months 5.
- A study of patients hospitalized with COVID-19 found that 52.4% had a tracheostomy, 78.7% had been intubated, and 69.5% were delirious, all of which can contribute to the development of dysphagia 6.
Management of Dysphagia in COVID-19 Patients
- Tracheostomy can reduce laryngopharyngeal trauma, sedation, delirium, ICU stay, and improve swallowing rehabilitation 2.
- Intensive swallow rehabilitation is crucial to manage dysphagia associated with COVID-19, including therapeutic respiratory weaning for those with a tracheostomy 3.
- Individualized compensatory strategies and direct exercises can be effective in improving swallowing and voice outcomes in patients with COVID-19 6.
- Dysphagia care is based on adaptation of practices to the patients' multiple impairments, and services preparing for COVID-19 should target resources for tracheostomy weaning and responsive management of dysphagia and dysphonia 2, 6.