From the Guidelines
Post-COVID-19 dysphagia should be managed with a multidisciplinary approach, prioritizing speech-language pathology evaluation and therapy, and considering dietary modifications, alternative feeding methods, and medications as needed, to minimize morbidity, mortality, and improve quality of life. The causes of post-COVID-19 dysphagia are multifactorial, including prolonged intubation, neurological complications, respiratory muscle weakness, and general deconditioning 1.
Management Strategies
- Speech-language pathology evaluation and therapy should be the cornerstone of treatment, including instrumental evaluations like videofluoroscopy or fiberoptic endoscopic evaluation of swallowing 1.
- Dietary modifications may be necessary, starting with thickened liquids and soft foods, gradually advancing as tolerated, and considering texture-adapted food after extubation 1.
- Alternative feeding methods like nasogastric tubes may be required in severe cases, and enteral nutrition (EN) should be administered if swallowing is proven unsafe 1.
- Medications like metoclopramide 5-10mg before meals may be considered for gastric emptying if gastroparesis is present, although they are not typically first-line treatment 1.
Key Considerations
- Post-extubation swallowing disorder can be prolonged, lasting up to 21 days, mainly in the elderly and after prolonged intubation, making it a significant complication for COVID-19 patients 1.
- The presence of severe post-extubation dysphagia is associated with severe outcomes, including pneumonia, reintubation, and hospital mortality, emphasizing the need for early and effective management 1.
- Patients with dysphagia should be referred to a speech-language pathologist for a comprehensive swallowing assessment to prevent oral nutrition complications and ensure optimal nutritional care 1.
Nutritional Support
- Optimisation of oral intake should be the first-line intervention, with dietary counselling and individualised nutrition from an experienced professional 1.
- Oral nutritional supplements (ONS) may be necessary, with criteria for their use varying, but should be stopped when goals have been met and malnutrition risk is resolved 1.
- Artificial nutrition, including enteral nutrition (EN) and parenteral nutrition (PN), should be considered based on individual patient needs and tolerance, with PN preferred in patients with expected respiratory complications 1.
From the Research
Causes of Post-COVID-19 Dysphagia
- Dysphagia in post-COVID-19 patients can result from primary damage to the central and peripheral neuronal swallowing network 2
- Prolonged intensive care treatment and mechanical ventilation can also lead to swallowing disorders 2
- COVID-19 can cause reduced pharyngolaryngeal coordination due to SARS-CoV-2 tropism to the central and/or peripheral nervous system 3
- Other possible causes of COVID-19-associated dysphagia include stroke, encephalitis, critical illness neuropathy, Guillain-Barré syndrome, and skeletal muscle injury 3
Management of Post-COVID-19 Dysphagia
- Structured disease-specific monitoring of dysphagia symptoms should be integrated into the treatment of COVID-19 patients 2
- Respiratory therapy should be an essential part of dysphagia management to re-establish cough effectiveness and breathing-swallowing coordination 2
- Tracheostomy can reduce laryngopharyngeal trauma, sedation, delirium, ICU stay, and improve swallowing rehabilitation 4
- Dysphagia care is based on adaptation of practices to the patients' multiple impairments, including respiratory compromise, deconditioning, and neurological complications 4
- Botulinum toxin type A injection can be a valid treatment option to improve the swallowing function in patients with post COVID-19 dysphagia 3
- Electrophysiology can be a useful tool for the diagnosis and follow-up of patients with oropharyngeal dysphagia 3
- Compensatory methods, texture-modified foods, and postural strategies can be used as a main approach to rehabilitation during the COVID-19 pandemic 5
- Home-based exercise programs should be encouraged, and direct treatment methods should be avoided 5