Dysphagia characteristics at FEES examination in post-extubation patients with COVID-19

Area of Science:

• Otolaryngology
• Critical Care Medicine
• Neurology

Background:

• Severe COVID-19 can lead to prolonged intubation and intensive care unit (ICU) stays.
• Post-ICU patients frequently exhibit dysphagia, impacting oral intake and recovery.
• Fibreoptic endoscopic evaluation of swallowing (FEES) is a key diagnostic tool for assessing swallowing function.

Purpose of the Study:

• To analyze Fibreoptic Endoscopic Evaluation of Swallowing (FEES) findings in tube-fed patients recovering from COVID-19.
• To characterize swallowing impairments and their progression in severe COVID-19 survivors.
• To evaluate the effectiveness of interventions and recovery trajectories using FEES and Functional Oral Intake Scale (FOIS) scores.

Main Methods:

• Seventeen intubated patients post-ICU stay underwent FEES assessments.
• Evaluated parameters included pooling of secretions, dysphagia phenotype, penetration/aspiration, and post-swallow residue.
• Functional Oral Intake Scale (FOIS) scores were recorded, with repeat FEES after two weeks for those with significant impairment.

Main Results:

• All 17 patients were initially tube-fed.
• FEES revealed common dysphagia phenotypes such as propulsive deficit and delayed pharyngeal phase.
• Pooling of secretions, penetration/aspiration, and residue were frequently observed; 7 patients transitioned to partial or total oral feeding.
• Significant improvement in FOIS scores was noted by the second FEES examination.

Conclusions:

• Swallowing impairment in severe COVID-19 survivors is characterized by propulsive deficits and delayed pharyngeal phases.
• Despite improvements, many patients require ongoing feeding modifications due to persistent swallowing difficulties.
• FEES is crucial for identifying specific swallowing issues and monitoring recovery in post-COVID-19 patients.