A consensus statement for the management and rehabilitation of communication and swallowing function in the ICU: A global response to COVID-19

Arch Phys Med Rehabil. 2020 Nov 6;S0003-9993(20)31210-7. doi: 10.1016/j.apmr.2020.10.113. Online ahead of print.

Abstract

Objective: To identify core practices for workforce management of communication and swallowing functions in COVID-19 positive patients within the ICU.

Design: A modified Delphi methodology was utilized, with 3 electronic voting rounds. AGREE II and an adapted COVID-19 survey framework from physiotherapy were used to develop survey statements. Sixty-six statements pertaining to workforce planning and management of communication and swallowing function in the ICU were included.

Setting: Electronic modified Delphi process.

Participants: 35 speech-language pathologists (SLPs) from 6 continents representing 12 countries.

Interventions: Not applicable.

Main outcome measures: The main outcome was consensus agreement, defined a priori as ≥70% of participants with a mean Likert score ≥7.0 (11-point scale: "0" = strongly disagree, "10" strongly agree). Prioritization rank order of statements in a 4th round was also conducted.

Results: SLPs with a median of 15 years ICU experience, working primarily in clinical (54%), in academic (29%) or managerial (17%) positions, completed all voting rounds. After the third round, 64 statements (97%) met criteria. Rank ordering identified issues of high importance.

Conclusions: A set of global consensus statements to facilitate planning and delivery of rehabilitative care for patients admitted to the ICU during the COVID-19 pandemic were agreed by an international expert SLP group. Statements focus on considerations for workforce preparation, resourcing and training, and the management of communication and swallowing functions. These statements support and provide direction for all members of the rehabilitation team to use for patients admitted to the ICU during a global pandemic.

Keywords: communication; critical care; deglutition disorders; severe acute respiratory syndrome coronavirus 2; telemedicine.