Dissertação
Sarcopenia e deglutição em pacientes pós-covid-19
Fecha
2022-09-14Autor
Berni, Viviane Bohrer
Institución
Resumen
COVID-19 is a respiratory disease of multisystemic nature, caused by the new
coronavirus, SARS-CoV-2, which can be asymptomatic or manifest as mild to severe
symptoms. In more severe cases, marked by protein hypercatabolism and prolonged
physical inactivity, musculoskeletal repercussions with loss of strength, muscle mass
and impaired swallowing function are expected after admission to the Intensive Care
Unit. The aim of this study was to investigate and relate the occurrence of sarcopenia
and the myoelectric activity of the suprahyoid region of post-COVID-19 patients,
stratified by disease severity and sex. This is a cross-sectional and observational
study, developed in the Ambulatório de Reabilitação Pós COVID-19 of the Hospital
Universitário de Santa Maria (HUSM), RS, in the period from April to September
2021. The sample consisted of 50 patients, of both genders, with a predominant age
range between 40 and 59 years, who were admitted to the Unidade de Tratamento
Intensivo (UTI) da COVID-19 of the aforementioned hospital. They were stratified into
critically ill patients (31 patients), who required only oxygen supplementation at
admission, and critically ill patients (19 patients), who required orotracheal intubation
and invasive mechanical ventilation. All patients underwent clinical evaluation of
swallowing by the Protocolo Fonoaudiológico de Avaliação do Risco de Disfagia
(PARD) and electrical activity of the muscles of the suprahyoid region by surface
electromyography (EMGs). Peripheral muscle mass and strength were checked by
ultrasonography (US), bioimpedance (BIA) and dynamometry, respectively. The
critically ill patients showed loss of peripheral muscle strength, with no loss of muscle
mass and no change in the myoelectric activity of the suprahyoid region. In the
evaluation of the risk of dysphagia, swallowing was classified as normal, for the most
part. When considering gender, female patients had lower strength, regardless of the
COVID-19 severity classification. Male patients presented loss of mass in both
groups. The women in the severe group had higher myoelectric activity of the
suprahyoid region at rest, when swallowing pasty and when swallowing liquids.
These patients, in the clinical evaluation of swallowing, presented multiple swallowing
in the pasty consistency and coughing when swallowing liquids. The correlations
between muscle condition and myoelectric activity of the suprahyoid region,
considering disease severity and gender, were significant only in the severe group. It
was concluded that critically ill male patients had sarcopenia, while female patients
had pre-sarcopenia. The relationship between muscle condition and myoelectric
activity in the suprahyoid region was evidenced only in the severe group, suggestig
that COVID-19 can compromisse the muscles involved in swallowing even in noncritical patients. Thus, the evaluation of such aspects in post-COVID-19 patients is of
paramount importance to implemente rehabilitation and restore functionality after
hospital discharge.