Impact of COVID-19 Infection and Intubation on Voice, Communication, and Quality of Life After Hospital Discharge

Introduction: Patients with Coronavirus Disease 2019 (COVID) who required ICU care were intubated for extended periods of time. Prolonged intubation increases the risk of acute laryngeal injury. This study investigates the burden of COVID infection and intubation on laryngeal function, voice, communication, and quality of life after hospital discharge.

Methods: This is a multicenter, prospective cohort review of patients who were diagnosed with COVID and admitted to the ICU. Clinical data was collected from the EMR, and patients were contacted to participate in remote assessment via standardized patient reported outcome measures: Voice Handicap Index (VHI-10), The Communicative Participation Item Bank (CPIB), Clinical COPD Questionnaire (CCQ). T-test and multivariate analysis were used to evaluate the data.

Results: Of 310 patients that enrolled from 12 institutions, 287 had COVID infection, 271 were admitted to the ICU, 221 were intubated (81.5%), 83 required tracheostomy (37.6%). This is more than double the historic rate for non-COVID patients intubated in the ICU. 18% of trach patients still had a trach at the time of follow up (mean time to survey follow-up: 489 days after discharge, 95% CI: 452-526). Mean time intubated was 17 days (95% CI: 15-19). Median size of ETT was 7.5. Length of intubation is associated with worse CCQ score controlling for ETT size (p = 0.04). Intubation was associated with higher average VHI-10 score (15 vs 10; p = 0.01). Similarly, CPIB score was lower in the intubated group (27 vs 30; p < 0.01). Multivariate analysis did not show a relationship between duration of intubation and VHI-10 or CPIB scores controlling for ETT size.

Conclusions: Results suggest patients intubated for COVID were more than twice as likely to require a tracheotomy than non-COVID patients. There are negative vocal and communication consequences associated with intubation. Longer length of intubation is associated with worse CCQ, indicating poorer quality of life related to breathing. Considering the mean time between discharge and the survey was 489 days, we can conclude these deleterious effects from intubation are enduring.