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.

中文翻译：

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COVID-19 住院患者的吞咽和发音结果：一项观察性队列研究

客观的

评估 2019 年冠状病毒病 (COVID-19) 住院患者出现发音困难和吞咽困难的表现和结果，以调查趋势并为持续护理的潜在途径提供信息。

设计

观察性队列研究。

环境

位于英国伦敦的内城国民健康服务医院信托基金。

参与者

从 2020 年 4 月开始，所有因 COVID-19 住院的成年住院患者（N = 164）被转诊到言语和语言治疗 (SLT) 进行语音和/或吞咽评估，为期 2 个月。

干预

SLT 评估、建议和治疗发声困难和吞咽困难。

主要观察指标

收集了谵妄、神经系统表现、插管、气管切开术和俯卧位史的证据，以及提供的 SLT 类型和出院结果。记录了吞咽和气管切开术前后 SLT 干预的治疗结果测量以及声音的粗糙呼吸乏力应变量表。

结果

包括年龄为 56.8±16.7 岁的患者（N=164；104 名男性）。一半 (52.4%) 进行了气管切开术，78.7% 进行了插管（平均 15±6.6 天），13.4% 有新的神经功能障碍，69.5% 神志不清。个性化补偿策略在所有和直接练习中进行了试验，占 11%。基线评估显示吞咽困难和声音明显受损，但在研究期间所有方面都有显着改善（P<.0001）。平均而言，患者在初始 SLT 评估（四分位距 [IQR]，0-8）后 2 天开始一​​些口服摄入，并且在出院时正常饮食，但 29.3%（n=29）的患者和 56.1% 的患者有吞咽困难（ n=37) 的发音困难患者在出院时仍然受损。共有 70.9% 的气管造口患者拔管，拔管的中位时间为 19 天（IQR，16-27）。在 164 名患者中，37.3% 的患者在住院期间完成了 SLT 输入，23.5% 的患者转至另一家医院，17.1% 的患者有声音，7.8% 的患者因吞咽困难需要社区随访。

结论

COVID-19 住院患者出现严重的声音和吞咽障碍，证明响应性 SLT 是合理的。长时间插管和气管切开是常态，少数有新的神经系统表现。患者通常会通过评估得到改善，该评估能够采用个性化的补偿策略进行治疗。为 COVID-19 做准备的服务应针对气管造口术撤机的资源，并通过稳健的转诊途径实现对吞咽困难和发音困难的响应性管理。