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Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study
To explore laryngeal function of tracheostomised patients with COVID-19 in the acute phase, to identify ways teams may facilitate and expedite tracheostomy weaning and rehabilitation of upper airway function. Consecutive tracheostomised patients underwent laryngeal examination during mechanical vent...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287536/ https://www.ncbi.nlm.nih.gov/pubmed/35841455 http://dx.doi.org/10.1007/s00455-022-10496-4 |
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author | Dawson, C. Nankivell, P. Pracy, J. P. Capewell, R. Wood, M. Weblin, J. Parekh, D. Patel, J. Skoretz, S. A. Sharma, N. |
author_facet | Dawson, C. Nankivell, P. Pracy, J. P. Capewell, R. Wood, M. Weblin, J. Parekh, D. Patel, J. Skoretz, S. A. Sharma, N. |
author_sort | Dawson, C. |
collection | PubMed |
description | To explore laryngeal function of tracheostomised patients with COVID-19 in the acute phase, to identify ways teams may facilitate and expedite tracheostomy weaning and rehabilitation of upper airway function. Consecutive tracheostomised patients underwent laryngeal examination during mechanical ventilation weaning. Primary outcomes included prevalence of upper aerodigestive oedema and airway protection during swallow, tracheostomy duration, ICU frailty scores, and oral intake type. Analyses included bivariate associations and exploratory multivariable regressions. 48 consecutive patients who underwent tracheostomy insertion as part of their respiratory wean following invasive ventilation in a single UK tertiary hospital were included. 21 (43.8%) had impaired airway protection on swallow (PAS ≥ 3) with 32 (66.7%) having marked airway oedema in at least one laryngeal area. Impaired airway protection was associated with longer total artificial airway duration (p = 0.008), longer tracheostomy tube duration (p = 0.007), multiple intubations (p = 0.006) and was associated with persistent ICU acquired weakness at ICU discharge (p = 0.03). Impaired airway protection was also an independent predictor for longer tracheostomy tube duration (p = 0.02, Beta 0.38, 95% CI 2.36 to 27.16). The majority of our study patients presented with complex laryngeal findings which were associated with impaired airway protection. We suggest a proactive standardized scoring and review protocol to manage this complex group of patients in order to maximize health outcomes and ICU resources. Early laryngeal assessment may facilitate weaning from invasive mechanical ventilation and liberation from tracheostomy, as well as practical and objective risk stratification for patients regarding decannulation and feeding. |
format | Online Article Text |
id | pubmed-9287536 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-92875362022-07-18 Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study Dawson, C. Nankivell, P. Pracy, J. P. Capewell, R. Wood, M. Weblin, J. Parekh, D. Patel, J. Skoretz, S. A. Sharma, N. Dysphagia Original Article To explore laryngeal function of tracheostomised patients with COVID-19 in the acute phase, to identify ways teams may facilitate and expedite tracheostomy weaning and rehabilitation of upper airway function. Consecutive tracheostomised patients underwent laryngeal examination during mechanical ventilation weaning. Primary outcomes included prevalence of upper aerodigestive oedema and airway protection during swallow, tracheostomy duration, ICU frailty scores, and oral intake type. Analyses included bivariate associations and exploratory multivariable regressions. 48 consecutive patients who underwent tracheostomy insertion as part of their respiratory wean following invasive ventilation in a single UK tertiary hospital were included. 21 (43.8%) had impaired airway protection on swallow (PAS ≥ 3) with 32 (66.7%) having marked airway oedema in at least one laryngeal area. Impaired airway protection was associated with longer total artificial airway duration (p = 0.008), longer tracheostomy tube duration (p = 0.007), multiple intubations (p = 0.006) and was associated with persistent ICU acquired weakness at ICU discharge (p = 0.03). Impaired airway protection was also an independent predictor for longer tracheostomy tube duration (p = 0.02, Beta 0.38, 95% CI 2.36 to 27.16). The majority of our study patients presented with complex laryngeal findings which were associated with impaired airway protection. We suggest a proactive standardized scoring and review protocol to manage this complex group of patients in order to maximize health outcomes and ICU resources. Early laryngeal assessment may facilitate weaning from invasive mechanical ventilation and liberation from tracheostomy, as well as practical and objective risk stratification for patients regarding decannulation and feeding. Springer US 2022-07-16 2023 /pmc/articles/PMC9287536/ /pubmed/35841455 http://dx.doi.org/10.1007/s00455-022-10496-4 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Dawson, C. Nankivell, P. Pracy, J. P. Capewell, R. Wood, M. Weblin, J. Parekh, D. Patel, J. Skoretz, S. A. Sharma, N. Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study |
title | Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study |
title_full | Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study |
title_fullStr | Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study |
title_full_unstemmed | Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study |
title_short | Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study |
title_sort | functional laryngeal assessment in patients with tracheostomy following covid-19 a prospective cohort study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287536/ https://www.ncbi.nlm.nih.gov/pubmed/35841455 http://dx.doi.org/10.1007/s00455-022-10496-4 |
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