Swallowing function after severe COVID-19: early videofluoroscopic findings

Area of Science:

• Otolaryngology
• Pulmonology
• Gastroenterology

Background:

• COVID-19 survivors often experience sequelae affecting multiple organ systems.
• Acute Respiratory Distress Syndrome (ARDS) can lead to prolonged critical illness and recovery challenges.
• Swallowing dysfunction is a potential complication following intensive care unit (ICU) stays.

Purpose of the Study:

• To report initial findings from videofluoroscopy of swallowing (VFS) in patients recovering from COVID-19-related ARDS.
• To identify the prevalence and nature of swallowing impairments in this specific patient population.

Main Methods:

• Prospective analysis of 21 patients (14 male, 7 female) recently discharged from ICU after ARDS.
• Swallowing function assessed using VFS within 14 days of ICU discharge.
• Expert evaluation by a radiologist and phoniatrician using the Penetration-Aspiration Scale (PAS).

Main Results:

• Nineteen of 21 patients (90.5%) exhibited swallowing impairments.
• Sixteen patients (76%) showed direct penetration or aspiration, predominantly silent.
• Common findings included delayed pharyngeal phase, reduced tongue base propulsion, oral leaks, impaired laryngeal closure, and pharyngeal peristalsis deficits.

Conclusions:

• High prevalence of swallowing disorders, including silent aspiration, observed in post-ARDS COVID-19 patients.
• Impaired protective airway reflexes are a significant concern.
• Highlights the critical need for cautious bedside swallowing screening in patients with severe lung injury.