RML Specialty Hospital-Department of Rehabilitation, Hinsdale, IL, USA.
University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
Eur Arch Otorhinolaryngol. 2023 Sep;280(9):4255-4260. doi: 10.1007/s00405-023-08032-7. Epub 2023 May 24.
Long term acute care hospitals (LTACHs) saw a significant increase in COVID-19 patients with prolonged acute illness recovery. Speech language pathologists (SLP) in LTACHs were integral in assessing swallowing and providing rehabilitation for dysphagia, however, there is limited research on LTACHs and dysphagia. Our aim was to describe this unique dysphagia management experience to improve future patient care.
Retrospective chart reviews were conducted for patients admitted to RML Specialty Hospital for respiratory failure secondary to COVID-19 from April 1, 2020 to October 31, 2021. Demographic information, videofluoroscopic swallow study (VFSS) reports with Penetration and Aspiration Scale (PAS) scores and SLP notes were reviewed. Descriptive statistics and chi-square analysis were performed.
A total of 213 patients met inclusion criteria. Most patients presented with tracheostomy (93.9%) and were NPO (92.5%) on admission. A strong correlation (p = 0.029) was noted between dependence on mechanical ventilation and significant airway invasion, as indicated by PAS score of 7 or 8 on VFSS. There was a strong association (p = 0.001) between patients who had tracheostomy placed within 33 days of VFSS and recommendation for thin liquids. Upon discharge, the majority of patients (83.57%) transitioned successfully to oral diets, however, a strong association (p = 0.009) between higher age (≥ 62) and NPO at discharge was demonstrated.
Patients admitted post COVID-19 to LTACH, especially those requiring tracheostomy, demonstrated various degrees of dysphagia and benefited from SLP intervention and instrumental swallow assessments. Most patients admitted to LTACH for COVID-19 were successfully rehabilitated for dysphagia.
长期急性护理医院 (LTACH) 收治了大量 COVID-19 患者，这些患者的急性疾病恢复期延长。LTACH 中的言语语言病理学家 (SLP) 在评估吞咽功能和为吞咽困难提供康复方面发挥了重要作用，但关于 LTACH 和吞咽困难的研究有限。我们的目的是描述这种独特的吞咽困难管理经验，以改善未来的患者护理。
对 2020 年 4 月 1 日至 2021 年 10 月 31 日因 COVID-19 导致呼吸衰竭而入住 RML 专科医院的患者进行回顾性病历审查。审查了人口统计学信息、视频荧光透视吞咽研究 (VFSS) 报告和渗透-吸痰量表 (PAS) 评分以及 SLP 记录。进行了描述性统计和卡方分析。
共有 213 名患者符合纳入标准。大多数患者入院时带有气管造口术 (93.9%)，且为禁食状态 (92.5%)。VFSS 上 PAS 评分为 7 或 8 分的患者，机械通气依赖程度与气道严重侵犯之间存在显著相关性 (p=0.029)。VFSS 后 33 天内放置气管造口术与推荐稀薄液体之间存在很强的关联 (p=0.001)。出院时，大多数患者 (83.57%)成功过渡到口服饮食，但年龄较高 (≥62 岁) 与出院时仍为禁食状态之间存在很强的关联 (p=0.009)。
因 COVID-19 入住 LTACH 的患者，尤其是需要气管造口术的患者，表现出不同程度的吞咽困难，并受益于 SLP 干预和仪器吞咽评估。大多数因 COVID-19 入住 LTACH 的患者在吞咽困难方面得到了成功康复。
