Impact of COVID-19 on Patient-Provider Communication in Critical Care: Case Reports

INTRODUCTION Communication impairment during mechanical ventilation and prolonged critical illness is extremely frustrating and frightening for patients and increases the risk for miscommunication, misinterpretation, and poor outcomes. The COVID-19 pandemic amplified patient communication impairment in intensive care units. This article presents 3 case examples from the experience of a team of hospital-based speech-language pathologists providing augmentative and alternative communication support resources and services to intensive care unit patients treated for COVID-19 during the first wave of the pandemic. Cases were selected to illustrate the protracted and complex in-hospital and rehabilitative recovery of critically ill patients with COVID-19, necessitating creative problem-solving and nursing collaborations with speech-language pathologists to support patient-provider communication. CLINICAL FINDINGS The cases demonstrate (1) increased need for bilingual communication resources, (2) impaired cognitive and motor function associated with a variety of post-COVID-19 sequelae including severe critical illness myopathy, and (3) delayed transition to a speaking valve due to the secretion burden. DIAGNOSES COVID-19 and acute respiratory distress syndrome (all), cerebral microhemorrhage, multi-system organ failure, hypoxic brain injury, altered mental status, seizure, stroke. INTERVENTIONS Multimodal and progressive augmentative and alternative communication interventions included low-technology strategies and simple communication boards, video language interpretation, tracheostomy speaking strategies, and a video intercom system. OUTCOMES All patients made progressive gains in communication ability. CONCLUSION Evaluation by augmentative and alternative communication specialists and progressive intervention from speech-language pathologists in collaboration with intensive care unit nurses can greatly improve patient-provider communication during treatment for and recovery from COVID-19 and other prolonged critical illnesses.