Swallowing function after severe COVID-19: early videofluoroscopic findings

Abstract

Introduction: The aim of this paper is to describe the early findings of swallowing analysis with videofluoroscopy of swallowing (VFS). Methods: The 21 first patients (14 men and 7 women) who recovered from ARDS in context of COVID-19 were referred to VFS just before to maximum 14 days after their discharge from ICU. The swallowing impairments and the physiopathologic mechanism of them were prospectively analyzed by two swallowing experts: one radiologist, and one phoniatrician using penetration-aspiration scale (PAS) score. Results: Nineteen out of 21 presented impairment in their swallowing function. Sixteen patients presented direct penetration or inhalation. All but one were silent. Some stases were also observed in 13 patients. Five patients presented secondary penetration/aspiration, among these inhalations, and all were silent. The most frequent findings are the delayed pharyngeal phase, the reduced propulsion of the tongue root, the posterior oral leaks, the default of laryngeal closure, and the impaired pharyngeal peristaltism. Discussion: The very high prevalence of swallowing disorders with inhalation and the lack of protective reflexes are the main findings. This emphasizes the need of high caution with bedside screening in these patients with severely injured lungs.