Successful treatment of intubation-induced severe neurogenic post-extubation dysphagia using pharyngeal electrical stimulation in a COVID-19 survivor: a case report.
Successful treatment of intubation-induced severe neurogenic post-extubation dysphagia using pharyngeal electrical stimulation in a COVID-19 survivor: a case report.
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DOI：
10.1186/s13256-021-02763-z
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发表时间：
2021-03-22
影响因子：
1
通讯作者：
Neuhold S
中科院分区：
文献类型：
--
作者：
Traugott M;Hoepler W;Kitzberger R;Pavlata S;Seitz T;Baumgartner S;Placher-Sorko G;Pirker-Krassnig D;Ehehalt U;Grasnek A;Beham-Kacerovsky M;Friese E;Wenisch C;Neuhold S
患有冠状病毒病2019年(新冠肺炎)的危重患者中，有很大一部分因需要长时间机械通气而患上重症监护病房(ICU)获得性吞咽功能障碍(神经源性吞咽困难)的风险很高。咽电刺激是治疗神经源性吞咽困难的一种简单、安全的治疗方法。研究表明，PES可以恢复重症卒中后经口腔插管或气管切开的ICU神经源性吞咽困难患者的安全吞咽功能。我们报告一位因新冠肺炎插管时间延长及严重全身肌肉无力而导致严重神经源性吞咽困难(PED)的病例，并成功使用PES进行治疗。一名71岁高加索女性患者，确诊为严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)感染，在ICU长时间插管后出现神经源性吞咽困难。为了避免气雾剂生成程序，按照最近发布的应对新冠肺炎大流行的国际指南的建议，对她的吞咽功能进行了非器质性评估。她的吞咽功能明显受损，建议进行PES治疗。PES导致PED的迅速改善，通过使用古格吞咽筛查(GUSS)和吞咽困难严重程度评定量表(DSRs)进行床边吞咽评估，以及使用功能性口服摄入量量表(FOIS)进行饮食筛选来评估。这些措施所反映的吞咽情况的改善，使这名患者在完成PES治疗5天后，就可以从ICU转到非重症医学科。PES治疗有助于这位患有新冠肺炎和重症监护病房获得性吞咽功能障碍的危重患者恢复安全的吞咽功能。新冠肺炎患者的早期临床床边吞咽评估和吞咽困难干预是优化其完全康复的关键。PES有助于ICU获得性吞咽功能障碍患者更安全、更早地出院。早期ICU出院和降低PES后的重新插管率有助于缓解ICU床位容量的一些压力，这在卫生紧急情况下(如正在进行的新冠肺炎大流行)至关重要。
A significant portion of critically ill patients with coronavirus disease 2019 (COVID-19) are at high risk of developing intensive care unit (ICU)-acquired swallowing dysfunction (neurogenic dysphagia) as a consequence of requiring prolonged mechanical ventilation. Pharyngeal electrical stimulation (PES) is a simple and safe treatment for neurogenic dysphagia. It has been shown that PES can restore safe swallowing in orally intubated or tracheotomized ICU patients with neurogenic dysphagia following severe stroke. We report the case of a patient with severe neurogenic post-extubation dysphagia (PED) due to prolonged intubation and severe general muscle weakness related to COVID-19, which was successfully treated using PES. A 71-year-old Caucasian female patient with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection developed neurogenic dysphagia following prolonged intubation in the ICU. To avoid aerosol-generating procedures, her swallowing function was evaluated non-instrumentally as recommended by recently published international guidelines in response to the COVID-19 pandemic. Her swallowing function was markedly impaired and PES therapy was recommended. PES led to a rapid improvement of the PED, as evaluated by bedside swallowing assessments using the Gugging Swallowing Screen (GUSS) and Dysphagia Severity Rating Scale (DSRS), and diet screening using the Functional Oral Intake Scale (FOIS). The improved swallowing, as reflected by these measures, allowed this patient to transfer from the ICU to a non-intensive medical department 5 days after completing PES treatment. PES treatment contributed to the restoration of a safe swallowing function in this critically ill patient with COVID-19 and ICU-acquired swallowing dysfunction. Early clinical bedside swallowing assessment and dysphagia intervention in COVID-19 patients is crucial to optimize their full recovery. PES may contribute to a safe and earlier ICU discharge of patients with ICU-acquired swallowing dysfunction. Earlier ICU discharge and reduced rates of re-intubation following PES can help alleviate some of the pressure on ICU bed capacity, which is critical in times of a health emergency such as the ongoing COVID-19 pandemic.
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期刊：
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