接受经口气管插管的冠状病毒病患者的吞咽困难
Dysphagia in patients with coronavirus disease undergoing orotracheal intubation.
作者信息
Almeida Vinícius Pereira Barbosa, Félix Letícia, Tavares Tracy Lima, da Silva Castro Mariana Marques, Tiago Romualdo Suzano Louzeiro
机构信息
Otorhinolaryngology Service, Department of Laryngology and Cervicofacial Surgery Institute of Medical Assistance to the State Public Servant (IAMSPE) São Paulo Brazil.
出版信息
Laryngoscope Investig Otolaryngol. 2022 Aug 10;7(5):1474-80. doi: 10.1002/lio2.886.
OBJECTIVE
To assess the incidence and the risk factors for the development of dysphagia in patients with coronavirus disease 2019 (COVID-19) undergoing orotracheal intubation.
STUDY DESIGN
Prospective cohort study.
METHODS
In this prospective cohort study, we evaluated consecutive patients diagnosed with COVID-19 and underwent orotracheal intubation were evaluated. During hospitalization, extubated patients were classified as dysphagic and nondysphagic based on bedside functional assessment of swallowing. Patients discharged from hospital were asked to complete the Eating Assessment Tool-10 (EAT-10) questionnaire, followed by an endoscopic examination to identify laryngotracheal lesions, and a fiberoptic endoscopic evaluation of swallowing (FEES). The food consistencies used for FEES were moderately thick, extremely thick, thin, and regular.
RESULTS
Based on the functional assessment of swallowing, performed a mean of 5.3 days and a median of 4 days after extubation, the incidence of dysphagia in patients with COVID-19 undergoing orotracheal intubation was 53.6%. In the late evaluation, performed a mean of 102 days after extubation, 12.8% of patients had an EAT-10 score >2. Orotracheal intubation (OTI) duration and tracheostomy were risk factors for the development of dysphagia. There was an association between EAT-10 > 2 and the presence of laryngotracheal lesion, with no difference between lesion type and EAT score >2.
CONCLUSIONS
The incidence of dysphagia varied according to the time of assessment, being higher the earlier the assessment after extubation. OTI duration and tracheostomy were risk factors for the development of dysphagia, and the presence of laryngotracheal lesions demonstrated an association with dysphagia.
LEVEL OF EVIDENCE
目的
评估接受气管插管的2019冠状病毒病（COVID-19）患者吞咽困难的发生率及相关危险因素。
研究设计
前瞻性队列研究。
方法
在这项前瞻性队列研究中，我们对连续诊断为COVID-19并接受气管插管的患者进行了评估。住院期间，根据床边吞咽功能评估，将拔管患者分为吞咽困难组和非吞咽困难组。出院患者被要求完成饮食评估工具-10（EAT-10）问卷，随后进行内镜检查以确定喉气管病变，并进行纤维喉镜吞咽功能评估（FEES）。FEES使用的食物稠度为中度浓稠、极度浓稠、稀薄和正常。
结果
基于拔管后平均5.3天（中位数4天）进行的吞咽功能评估，接受气管插管的COVID-19患者吞咽困难的发生率为53.6%。在拔管后平均102天进行的后期评估中，12.8%的患者EAT-10评分>2。气管插管（OTI）持续时间和气管切开术是吞咽困难发生的危险因素。EAT-10>2与喉气管病变的存在之间存在关联，病变类型与EAT评分>2之间无差异。
结论
吞咽困难的发生率根据评估时间而异，拔管后评估越早发生率越高。OTI持续时间和气管切开术是吞咽困难发生的危险因素，喉气管病变的存在与吞咽困难相关。
证据级别
3级。
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