Voice Outcomes of Patients Intubated for Critical COVID Illness: A Multicenter Study
Francesco F. Caruana, Alexander Gelbard, David Francis, Michael J. Pitman, Elena P. Kennedy, Joel Blumin, Jonathan Bock, Matthew Clary, Quinlyn Axelson, Laura Matrka, Patrick McGarey, James Daniero, Phillip Weissbrod, Yin Yiu, Daniel Gorelik, Robert J. Morrison, Shady SolimanAbstract
Objective
Characterize the long‐term vocal outcomes of patients who required ICU care for COVID‐19 infection.
Study Design
Prospective cohort study.
Setting
Multi‐institutional North American Airway Collaborative Study.
Methods
Patients with a COVID‐19 diagnosis requiring ICU admission were identified via ICD‐10 codes and recruited after discharge to complete patient‐reported outcome measures (PROM) in voice (Voice Handicap Index: VHI‐10), communication (Communicative Participation Item Bank: CPIB), and breathing (Clinical COPD Questionnaire: CCQ). Multivariate analysis investigated the association between clinical variables and PROMs.
Results
308 patients enrolled; 271 were admitted with COVID to the ICU. 221 were intubated (81.5%); 50 patients admitted to the ICU did not require intubation (18.5%). Mean follow‐up was 489 days after discharge (95% CI: 452‐526). Mean intubation duration was 17 days (95% CI: 15‐19). Median endotracheal tube (ETT) size was 7.5. Intubation was associated with higher VHI‐10 score (15 vs 10; P = .01) and lower CPIB score (27 vs 30; P < .01). When controlling for ETT size, multivariate analysis did not show a relationship between intubation duration and VHI‐10 or CPIB scores but was associated with worse CCQ score ( P = .04).
Conclusion
Survivors of COVID infection requiring ICU admission and intubation have persistent functional impairments in voicing and breathing more than 1 year after their hospitalization. While COVID survivorship and “long COVID” have centered on neuropsychiatric and metabolic outcomes, this study highlights the unappreciated negative impact of endotracheal intubation on voice and communication related to this illness and reinforces the relationship between duration of intubation and subjective dyspnea after surviving critical illness.