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COVID-19 大流行背景下 ICU 患者插管后吞咽困难的特征:巴西参考中心 920 例报告。

Characteristics of postintubation dysphagia in ICU patients in the context of the COVID-19 outbreak: A report of 920 cases from a Brazilian reference center.

机构信息

Department of Physiotherapy, Speech-Language and Hearing Science and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.

Division of Oral Myology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.

出版信息

PLoS One. 2022 Jun 16;17(6):e0270107. doi: 10.1371/journal.pone.0270107. eCollection 2022.

Abstract

The purpose of this research was to identify risk factors that were independently related to the maintenance of a swallowing dysfunction in patients affected by critical COVID-19. We conducted a prospective observational cohort study of critical patients with COVID-19, who were admitted to a COVID-19 dedicated intensive care unit (ICU) and required prolonged orotracheal intubation (≥48 hours). Demographic and clinical data were collected at ICU admission and/or at hospital discharge or in-hospital death. Swallowing data was based on The Functional Oral Intake Scale (FOIS) and was collected at two distinct moments: initial swallowing assessment and at patient outcome. Patients were divided into two groups according to their FOIS level assigned on the last swallowing assessment: in-hospital resolved dysphagia-patients with FOIS levels 6 and 7; non-resolved dysphagia at hospital outcome-patients with FOIS levels 1 to 5. Nine hundred and twenty patients were included in our study. Results of the multivariate logistic regression model for the prediction of non-resolved dysphagia at hospital outcome in critical COVID-19 patients. indicated that increasing age (p = 0.002), severity at admission (p = 0.015), body mass index (p = 0.008), use of neuromuscular blockers (p = 0.028), presence of neurologic diseases (p = 0.038), presence of Diabetes Mellitus (p = 0.043) and lower FOIS levels on the initial swallowing assessment (p<0.001) were associated with higher chances of presenting dysphagia at hospital outcome. Critical patients with COVID-19 may experience post-acute COVID-19 dysphagia, indicating the need to prepare for the care/rehabilitation of these patients.

摘要

本研究旨在确定与重症 COVID-19 患者吞咽功能障碍持续相关的独立危险因素。我们对入住 COVID-19 专用重症监护病房(ICU)并需要长时间(≥48 小时)经口气管插管的重症 COVID-19 患者进行了前瞻性观察队列研究。在 ICU 入院时和/或出院时或院内死亡时收集人口统计学和临床数据。吞咽数据基于功能性口腔摄入量表(FOIS),并在两个不同时间点收集:初始吞咽评估和患者结局。根据最后一次吞咽评估时分配的 FOIS 水平,将患者分为两组:住院期间吞咽功能恢复患者(FOIS 水平 6 和 7)和出院时吞咽功能未恢复患者(FOIS 水平 1 至 5)。本研究共纳入 920 例患者。多变量逻辑回归模型预测重症 COVID-19 患者出院时吞咽功能未恢复的结果表明,年龄增加(p=0.002)、入院时严重程度(p=0.015)、体重指数(p=0.008)、使用神经肌肉阻滞剂(p=0.028)、存在神经系统疾病(p=0.038)、存在糖尿病(p=0.043)和初始吞咽评估时 FOIS 水平较低(p<0.001)与出院时发生吞咽困难的几率较高相关。COVID-19 重症患者可能会出现急性 COVID-19 后吞咽困难,表明需要为这些患者的护理/康复做好准备。

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