BACKGROUND: The critically ill patients suffering from coronavirus disease (COVID-19) and admitted to the intensive care units (ICUs) are susceptible to a wide array of complications that can be life-threatening or impose them to long-term complications. The COVID-19 oral mucocutaneous complications require multidisciplinary management and research for their pathophysiological course and epidemiological significance; therefore, the objective of this study was to evaluate the prevalence and characteristics of the critically ill COVID-19 patients with oral complications. METHODS: We described the clinical and microbiological characteristics of the critically ill COVID-19 patients in our ICU department (Banska Bystrica, Slovakia). In addition, we reviewed the current body of evidence in Ovid MEDLINE®, Embase, Cochrane Library, and Google Scholar for the oral mucocutaneous complications of ICU patients with COVID-19. RESULTS: Three out of nine critically ill patients (33.3%) in our ICU department presented with oral complications including haemorrhagic ulcers and necrotic ulcers affecting the lips and tongue. The microbiological assessment revealed the presence of opportunistic pathogens, confirming the possibility of co-infection. On reviewing the current literature, two hundred ten critically ill patients were reported to have oral complications due to their stay in the ICU setting. Perioral pressure ulcers were the most common complication, followed by oral candidiasis, herpetic and haemorrhagic ulcers, and acute onset macroglossia. The prolonged prone positioning and mechanical ventilation devices were the primary risk factors for those oral complications, in addition to the immunosuppressive drugs. CONCLUSIONS: The multidisciplinary approach is strongly advocated for monitoring and management of COVID-19 patients, thus implying that dermatology and oral healthcare specialists and nurses should be integrated within the ICU teams.

Czech National Centre for Evidence Based Healthcare and Knowledge Translation Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Anaesthesiology F D Roosevelt University Hospital 975 17 Banska Bystrica Slovakia

Department of Clinical Microbiology F D Roosevelt University Hospital 975 17 Banska Bystrica Slovakia

Department of Maxillofacial Surgery F D Roosevelt University Hospital 975 17 Banska Bystrica Slovakia

Department of Nursing and Midwifery Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Prosthetic Dentistry Faculty of Medicine and Dentistry Palacky University 775 15 Olomouc Czech Republic

Department of Public Health Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

St Elizabeth University of Health and Social Work 812 50 Bratislava Slovakia