Post-resuscitation Critical Illness Dysphagia: A Case Report

Area of Science:

• Critical care medicine
• Neurology
• Gastroenterology

Background:

• Critical illness dysphagia (CID) frequently complicates prolonged intensive care unit (ICU) admissions, especially after mechanical ventilation.
• CID leads to increased morbidity, including aspiration pneumonia, extended hospital stays, and reliance on enteral nutrition.
• The causes of CID are multifactorial, encompassing oropharyngeal trauma, neuromuscular deficits, neurological injury, and disuse atrophy.

Observation:

• A case report details a male patient experiencing severe dysphagia post-ICU admission for cardiac arrest, mechanical ventilation, and multi-organ dysfunction.
• Diagnostic evaluations including laryngoscopy, MRI, autoimmune screening, fibreoptic endoscopic evaluation of swallowing (FEES), and videofluoroscopic swallow study (VFSS) excluded structural/neurological causes and confirmed silent aspiration.
• The patient required prolonged nasogastric feeding due to profound pharyngeal dysphagia.

Findings:

• A structured, multidisciplinary rehabilitation program involving speech and language therapy (SALT) and dietetics was implemented.
• Despite initial setbacks, the patient demonstrated progressive improvement, transitioning to a modified IDDSI level 2-3 diet for safe oral intake.
• Instrumental swallowing assessments like FEES and VFSS were pivotal in guiding clinical management and rehabilitation strategies.

Implications:

• This case underscores the complex nature of CID and the importance of early detection and coordinated care.
• Structured dysphagia rehabilitation programs are essential for improving functional outcomes in CID patients.
• Timely and appropriate interventions can facilitate meaningful recovery of swallowing function, potentially preventing long-term enteral feeding dependence.