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Post-Extubation Dysphagia and Dysphonia amongst Adults with COVID-19 in the Republic of Ireland: a Prospective Multi-Site Observational Cohort Study
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  • Julie Regan,
  • Margaret Walshe,
  • Sarah Lavan,
  • Eanna Horan,
  • Patricia Gillivan-Murphy,
  • Anne Healy,
  • Caoimhe Langan,
  • Karen Malherbe,
  • Breda Flynn Murphy,
  • Maria Cremin,
  • Denise Hilton,
  • Jenni Cavaliere,
  • Alice Whyte
Julie Regan
Trinity College Dublin

Corresponding Author:[email protected]

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Margaret Walshe
Trinity College Dublin
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Sarah Lavan
St. James' Hospital
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Eanna Horan
Tallaght University Hospital
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Patricia Gillivan-Murphy
Mater Misericordiae University Hospital
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Anne Healy
Beaumont Hospital
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Caoimhe Langan
St Vincent's University Hospital
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Karen Malherbe
Galway University Hospital
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Breda Flynn Murphy
Midland Regional Hospital Portlaoise
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Maria Cremin
University Hospital Kerry
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Denise Hilton
Cavan General Hospital
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Jenni Cavaliere
University Hospital Waterford
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Alice Whyte
Naas General Hospital
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Objectives: This study aims to (i) investigate post-extubation dysphagia and dysphonia amongst adults intubated with SARS-COV-2 (COVID-19) and referred to speech and language therapy (SLT) in acute hospitals across the Republic of Ireland (ROI) between March and June 2020; (ii) identify variables predictive of post-extubation oral intake status and dysphonia and (iii) establish SLT rehabilitation needs and services provided to this cohort. Design: A multi-site prospective observational cohort study Participants: 100 adults with confirmed COVID-19 who were intubated across eleven acute hospital sites in ROI and who were referred to SLT services between March and June 2020 inclusive. Main Outcome Measures: Oral intake status, level of diet modification and perceptual voice quality. Results: Based on initial SLT assessment, 90% required altered oral intake and 59% required tube feeding with 36% unable for oral intake. Age (OR 1.064; 95% CI 1.018-1.112), proning (OR 3.671; 95% CI 1.128-11.943), and pre-existing respiratory disease (OR 5.863; 95% CI 1.521-11.599) were predictors of oral intake status post-extubation. Two-thirds (66%) presented with dysphonia post-extubation. Intubation injury (OR 10.471; 95% CI 1.060-103.466) and pre-existing respiratory disease (OR 24.196; 95% CI 1.609-363.78) were predictors of post-extubation voice quality. Thirty-seven percent required dysphagia rehabilitation post-extubation whereas 20% needed voice rehabilitation. Dysphagia and dysphonia persisted in 27% and 37% cases respectively at hospital discharge. Discussion: Post-extubation dysphagia and dysphonia were prevalent amongst adults with COVID-19 across the ROI. Predictors included iatrogenic factors and underlying respiratory disease. Prompt evaluation and intervention is needed to minimise complications and inform rehabilitation planning.
15 Mar 2021Submitted to Clinical Otolaryngology
19 Mar 2021Submission Checks Completed
19 Mar 2021Assigned to Editor
14 Apr 2021Reviewer(s) Assigned
05 May 2021Review(s) Completed, Editorial Evaluation Pending
09 May 2021Editorial Decision: Revise Minor
14 May 20211st Revision Received
17 May 2021Submission Checks Completed
17 May 2021Assigned to Editor
26 May 2021Reviewer(s) Assigned
14 Jun 2021Review(s) Completed, Editorial Evaluation Pending
20 Jun 2021Editorial Decision: Accept