Long-term communication and swallowing disability in adults with persistent critical illness following COVID-19: A mixed-methods observational study.

OBJECTIVES

To describe the lived experience of communication and swallowing disability in adults with persistent critical illness following COVID-19.

METHODS

A mixed-methods study. Semi-structured interviews were conducted alongside patient-reported communication and swallowing outcome measures.

SETTING

Participants were recruited from a registry-embedded COVID-Recovery study. All patients were eligible if they were ≥ 18 years, positive PCR for SARS-CoV-2 and had persistent critical illness. This was defined as admission to ICU for >10 consecutive days with invasive mechanical ventilation for at least 24 h.

MAIN OUTCOME MEASURES: Semi-structured interviews were used to explore communication and swallowing disability. Additional patient-reported outcomes were assessed with the Dysphagia Severity Rating Scale and the La Trobe Communication Questionnaire. General function outcomes were evaluated with the WHODAS 2.0, EQ-5D-5L, HADS, MoCA-Blind, IADL and IES-6.

FINDINGS: Of the 113 participants followed up, 29/113 (26%) reported communication or swallowing disability, and of these 17/29 (59%) consented to semi-structured interviews. From the 16 participants who answered questions about communication function 100% self-reported difficulty in ≥1 communication domain, including expressive language 13/16 (81%), voice 13/16 (81%), receptive language 9/16 (56%) and speech 5/16 (31%). Although all participants were consuming an oral diet and most with nil texture restrictions (13/17,76%), many reported ongoing swallowing concerns regarding safety and efficiency. Impacts of these new disabilities were beyond physical function and impacted on their activities and participation. Recovery was unclear, prolonged and compounded by judgement from others. Participants navigated their own recovery journey and whilst some were well supported, others described critical healthcare gaps.

CONCLUSIONS

We identified approximately one quarter of people admitted to ICU for COVID-19 related critical illness with a length of stay of 10 days or more report ongoing communication and swallowing disability at 6 months. The impacts continued well beyond hospital discharge and highlight a need to specifically address swallowing and communication in recovery pathways.

IMPLICATIONS FOR CLINICAL PRACTICE: Specific assessment of communication and swallowing function is essential for individuals who experience persistent critical illness.