Table 1.
Rating scales for analysis of FEES examinations.
Table 2.
Characteristics of patients included in the study.
Table 3.
Total time in hospital and number of days in ICU, on ventilator, with intubation, and with tracheostomy (mean, median, and range).
Fig 1.
Penetration, aspiration, and residue during swallowing in COVID-19 patients treated in the ICU at the time of the first FEES examination.
Proportions of different degrees of impairment for boluses of different consistencies (carb = carbonated water, thick = mildly thick liquid, and thin = thin liquid). PAS denotes Penetration-Aspiration Scale (1 = no penetration or aspiration, 7–8 = aspiration to trachea; see Table 1). Residue after swallow is evaluated with the Yale Pharyngeal Residue Severity Scale (grade 1 = no residue, grade 5 = filled to the epiglottic rim or to the aryepiglottic folds, respectively; see Table 1). Dotted red filling represents patients in whom the boluses were considered unsafe and not given due to high risk for aspiration. Grey filling indicates the proportion of patients who did not receive the particular bolus for other reasons. NA denotes that the rating was not possible to perform due to insufficient visibility on the video.
Fig 2.
Proportions of pooling of secretions and recommendations of oral intake in COVID-19 patients treated in the ICU at the time of the first FEES examination.
Ratings of secretion were made according to the Murray Secretion Scale (“normal” refers to grade 1, no secretion, “mild” to grade 2, deeply pooled secretions, “moderate” to grade 3, transient pooling in the larynx, and “severe” to grade 4, secretions in the laryngeal vestibule). Ratings of recommendations of oral intake were made according to the Functional Oral Intake Scale (FOIS) (“normal” refers to grade 7, total oral intake without restriction, “mild” to grade 5–6, total oral intake with restrictions, “moderate” to grad 3–4, total oral intake with a single consistency or consistent oral intake with tube supplements, and “severe” to grade 1–2, tube dependent with no/minimal/inconsistent oral intake).
Fig 3.
Examples of findings during the FEES.
A) Secretions in vallecula and hypopharynx before first bolus. B) Penetration to the level of the vocal folds. C) Aspiration of thin liquid. D) Residue in hypopharynx and larynx after swallow. E) Edema in the arytenoid region on the left side. F) Bilateral vocal fold erythema.
Table 4.
Laryngeal findings.
Table 5.
Correlations between FEES ratings and abnormal laryngeal findings vs. duration of treatment for COVID-19.
Fig 4.
Box plots of FEES variables with a significance of p <0.05 on post-hoc analysis.
(A,B) Pooling of secretions; (C) Residue in the vallecula and (D) Arytenoid edema versus total time in hospital (A, C), number of days in ICU (B), and days with tracheostomy (D). Variables with a significance of p <0.05 on post-hoc analysis using the Kruskal-Wallis test are included. Median, 25th and 75th percentiles are shown.