Data collected during the 2020–21 COVID-19 alpha wave indicated dysphagia prevalence rates up to 93%. Whilst many patients recovered during hospital admission, some experienced persistent dysphagia ...with protracted recovery. To explore (1) prevalence, (2) treatment, and (3) recovery patterns and outcomes for swallowing, in the ICU patient with Delta and subsequent variants of COVID-19. Prospective observational study. Patients admitted to 26 Intensive Care Units (ICUs) over 12 months, diagnosed with COVID-19, treated for survival and seen by Speech–Language Pathology (SLP) for clinical swallowing assessment were included. Demographic, medical, SLP treatment, and swallowing outcome data were collected. 235 participants (63% male, median age = 58 years) were recruited. Median mechanical ventilation was 16 days, and ICU and hospital length of stay (LOS) were 20 and 42 days, respectively. ICU-Acquired Weakness (54%) and delirium (49%) were frequently observed. Prevalence of dysphagia was 94% with the majority (45%) exhibiting profound dysphagia (Functional Oral Intake Scale = 1) at initial assessment. Median duration to initiate oral feeding was 19 days (IQR = 11-44 days) from ICU admission, and 24% received dysphagia rehabilitation. Dysphagia recovery by hospital discharge was observed in 71% (median duration = 30 days IQR = 17-56 days). Positive linear associations were identified between duration of intubation, mechanical ventilation, hospital and ICU LOS, and duration to SLP assessment (
p
= 0.000), dysphagia severity (
p
= 0.000), commencing oral intake (
p
= 0.000), dysphagia recovery (
p
< 0.01), and enteral feeding (
p
= 0.000). Whilst older participants had more severe dysphagia (
p
= 0.028), younger participants took longer to commence oral feeding (
p
= 0.047). Dysphagia remains highly prevalent in ICU COVID-19 patients. Whilst invasive ventilation duration is associated with swallowing outcomes, more evidence on dysphagia pathophysiology is required to guide rehabilitation.
Furthermore, family members who take part in physical activity and other aspects of patient care are empowered by a proactive, participatory role 7. ...communication of high-stakes information to ...patients and families, whether on emotional subjects or related to decision-making, requires specialized training of healthcare professionals 6. ...effective use of interprofessional communication systems by team members can reduce risk of inconsistent messages or fragmented care, both of which can cause distress for patients and families 8.
Objectives: Critically ill adults requiring artificial airways experience profound communication deficits. Studies of interventions supporting communication report disparate outcomes, creating ...subsequent challenges in the interpretation of their effectiveness. Therefore, we aimed to develop international consensus for a communication core outcome set (Comm-COS) for future trials of communication interventions in this population. Design: 1) Systematic review, 2) patient/family interviews, 3) two-round modified Delphi, and 4) virtual consensus meetings with a final voting round. A multidisciplinary expert steering committee oversaw all stages. Setting: Interviews and consensus meetings were conducted via videoconferencing. Digital methods were used for Delphi and final Comm-COS voting. Subjects: Three stakeholder groups: 1) patient and family members with lived experience within 3 years, 2) clinicians with experience working in critical care, and 3) researchers publishing in the field. Intervention: None. Measurements and Main Results: We identified 59 outcomes via our systematic review, 3 unique outcomes from qualitative interviews, and 2 outcomes from our steering committee. Following item reduction, 32 outcomes were presented in Delphi round 1; 134 participants voted; 15 patient/family (11%), 91 clinicians (68%), and 28 researchers (21%). Nine additional outcomes were generated and added to round 2; 106 (81%) participants voted. Following completion of the consensus processes, the Comm-COS includes seven outcomes: 1) changes in emotions and wellbeing associated with ability to communicate, 2) physical impact of communication aid use, 3) time to functional communication, 4) ability to communicate healthcare needs (comfort/care/safety/decisions), 5) conversation agency, 6) ability to establish a communication connection to develop and maintain relationships, and 7) acceptability of the communication intervention. Conclusions: This is the first COS to specifically focus on communication for critically ill adults. Limitations for operationalization include selection of measures to use with these outcomes. Identification of suitable measures and adoption of the Comm-COS in future trials will help establish effective interventions to ameliorate the highly prevalent and negative experience of communicative incapacity.
The purpose of this systematic review was to examine safety-related outcomes for patients with tracheostomy after flexible endoscopic evaluation of swallowing (FEES) to assess and manage their ...swallow, when compared to other non-instrumental swallow assessments such as clinical swallowing examination (CSE) and/or a modified Evans blue dye test (MEBDT).
Three databases were searched for articles referring to safety-related outcome data for adults with a tracheostomy, who underwent FEES and CSE and/or MEBDT. Articles were screened using predefined inclusion/exclusion criteria.
The search strategy identified 2097 articles; following abstract and full-text screening, seven were included for review. The summary of evidence found low to very low certainty that FEES was associated with improved outcomes across swallow safety, physiological outcomes, tracheostomy cannulation duration, functional outcomes, and detection of upper airway pathologies.
This systematic review demonstrated low to very low certainty evidence from seven heterogeneous studies with low sample sizes that incorporating FEES may be associated with improved safety-related outcomes. There is less evidence supporting the accuracy of other swallow assessments conducted at the point of care (i.e. CSE and MEBDT). Future research requires studies with larger sample sizes and routine reporting of safety-related outcomes with use of FEES.
Significant investment in planning and training has occurred across the Australian healthcare sector in response to the COVID-19 pandemic, with a primary focus on the medical and nursing workforce. ...We provide a short summary of a recently published article titled “Surge capacity of Australian intensive care units associated with COVID-19 admissions” in the Medical Journal of Australia and, importantly, highlight a knowledge gap regarding critical care specialised allied health professional (AHP) workforce planning in Australia. The unique skill set provided by critical care specialised AHPs contributes to patient recovery long after the patient leaves the intensive care unit, with management targeted at reducing disability and improving function, activities of daily living, and quality of life. Allied health workforce planning and preparation during COVID-19 must be considered when planning comprehensive and evidence-based patient care. The work by Litton et al. has highlighted the significant lack of available data in relation to staffing of critical care specialised AHPs in Australia, and this needs to be urgently addressed.
Dysphonia and laryngeal pathology are considerable issues in patients hospitalised with COVID-19 with prevalence rates cited between 29% and 79%. Most studies currently are limited to reporting ...single-institution data with many retrospective.
The aims of this study were to prospectively explore the following: (i) prevalence; (ii) treatment; and (iii) recovery pattern and outcomes for dysphonia, in patients with COVID-19 requiring intensive care unit (ICU) treatment.
Patients admitted to 26 ICUs over 12 months, diagnosed with COVID-19, treated for survival, and seen by speech–language pathology for clinical voice assessment were considered. Demographic, medical, speech–language pathology treatment, and voice outcome data (grade, roughness, breathiness, asthenia, strain GRBAS) were collected on initial consultation and continuously monitored throughout the hospital admission.
Two-hundred and thirty five participants (63% male, median age = 58 yrs) were recruited. Median mechanical ventilation duration and ICU and hospital lengths of stay (LOSs) were 16, 20, and 42 days, respectively. Dysphonia prevalence was 72% (170/235), with 22% (38/170) exhibiting profound impairment (GRBAS score = 3). Of those with dysphonia, rehabilitation was provided in 32% (54/170) cases, with dysphonia recovery by hospital discharge observed in 66% (112/170, median duration = 35 days interquartile range = 21–61 days). Twenty-five percent (n = 42) of patients underwent nasendoscopy: oedema (40%, 17/42), granuloma (31%, 13/42), and vocal fold palsy/paresis (26%, 11/42). Presence of dysphonia was inversely associated with the number of intubations (p = 0.002), intubation duration (p = 0.037), ICU LOS (p = 0.003), and hospital LOS (p = 0.009). Conversely, duration of dysphonia was positively associated with the number of intubations (p = 0.012), durations of intubation (p = 0.000), tracheostomy (p = 0.004), mechanical ventilation (p = 0.000), ICU LOS (p = 0.000), and hospital LOS (p = 0.000). More severe dysphonia was associated with younger age (p = 0.045). Proning was not associated with presence (p = 0.075), severity (p = 0.164), or duration (p = 0.738) of dysphonia.
Dysphonia and laryngeal pathology are common in critically ill patients with COVID-19 and are associated with younger age and protracted recovery in those with longer critical care interventions.
To systematically review the research relating to views and experiences of people with disability eating out in cafés, restaurants, and other settings; and identify factors that impede or enhance ...accessibility of eating out experiences, inform future inclusive research, and guide policy development.
This study involved systematic search and review procedures with qualitative metasynthesis of the barriers to and facilitators for participation and inclusion in eating/dining-out activities. In total, 36 studies were included.
Most studies reviewed related to people with physical or sensory disability eating out, with few studies examining the dining experiences of adults with intellectual or developmental disability, swallowing disability, or communication disability. People with disability encountered negative attitudes and problems with physical and communicative access to the venue. Staff lacked knowledge of disability. Improvements in the design of dining spaces, consultation with the disability community, and staff training are needed.
People with disability may need support for inclusion in eating out activities, as they encounter a range of barriers to eating out. Further research within and across both a wide range of populations with disability and eating out settings could guide policy and practice and help develop training for hospitality staff.
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