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A Consensus Statement for the Management and Rehabilitation of Communication and Swallowing Function in the ICU: A Global Response to COVID-19.

Graduate School of Health, University of Technology, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; Critical Care Division, The George Institute for Global Health, Sydney, NSW, Australia. Electronic address: amy.freeman-sanderson@uts.edu.au. Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, QLD, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia. Speech Science, The University of Auckland, Auckland, New Zealand. Núcleo de Cardiologia/Centro de Reabilitação Cardiopulmomar, Hospital Sírio Libanês, Sao Paulo, Brazil; Comitê de Fonoaudiologia, BRASPEN/SBNPE (Sociedade Brasileira de Nutrição Parenteral e Enteral), Brazil. Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Speech and Language Therapy, Belfast Health and Social Care Trust, Belfast, UK. Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Nagoya, Japan. School of Allied Health, Midwifery and Social Care Faculty of Health, Social Care and Education, Kingston and St George's, University of London, London, UK; Speech and Language Therapy, University College London Hospitals NHS Foundation Trust, London, UK. Life The Crompton Hospital, Pinetown, KZN, South Africa; Life Westville Hospital, Durban, South Africa. School of Audiology and Speech Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada. Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland. Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD.

Archives of physical medicine and rehabilitation. 2021;(5):835-842
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Abstract

OBJECTIVE To identify core practices for workforce management of communication and swallowing functions in coronavirus disease 2019 (COVID-19) positive patients within the intensive care unit (ICU). DESIGN A modified Delphi methodology was used, 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 Speech-language pathologists (SLPs) (N=35) 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 fourth round was also conducted. RESULTS SLPs with a median of 15 years of ICU experience, working primarily in clinical (54%), academic (29%), or managerial positions (17%), 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 focused 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.