# Post-resuscitation Critical Illness Dysphagia: A Case Report

## TL;DR

This case report describes a patient who developed severe swallowing difficulties after a cardiac arrest and ICU treatment, highlighting the importance of multidisciplinary care and rehabilitation for recovery.

## Contribution

The paper presents a detailed case of post-resuscitation critical illness dysphagia and emphasizes the role of structured rehabilitation and instrumental assessments in recovery.

## Key findings

- The patient developed profound pharyngeal dysphagia with silent aspiration following ICU treatment.
- Multidisciplinary care and structured rehabilitation led to gradual improvement in swallowing function.
- Instrumental assessments like FEES and VFSS were crucial for guiding clinical decisions and recovery.

## Abstract

Critical illness dysphagia (CID) is a common complication affecting patients following prolonged intensive care unit (ICU) admissions, particularly those who undergo endotracheal intubation and mechanical ventilation. CID is associated with increased morbidity, including aspiration pneumonia, prolonged hospitalisation, and the need for enteral nutrition. The aetiology is multifactorial, involving oropharyngeal trauma, neuromuscular weakness, neurological insult, and disuse atrophy. We report the case of a male patient in his sixties admitted with fluid overload who subsequently experienced a pulseless electrical activity (PEA) cardiac arrest, requiring ICU admission, mechanical ventilation, and inotropic support. His ICU course was complicated by staphylococcal bacteraemia and multi-organ dysfunction. Following extubation, he developed severe dysphagia. Structural and neurological causes were excluded through laryngoscopy, MRI of the brain, and autoimmune screening. Serial swallowing assessments, including fibreoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallow study (VFSS), confirmed profound pharyngeal dysphagia with silent aspiration. He required prolonged nasogastric feeding. Multidisciplinary care involving gastroenterology, neurology, endocrinology, speech and language therapy (SALT), and dietetics guided a structured rehabilitation programme. Despite initial deterioration, the patient showed gradual improvement with ongoing therapy, eventually progressing to a safe oral intake on a modified International Dysphagia Diet Standardisation Initiative (IDDSI) level 2-3 diet. He was discharged home with outpatient SALT and nutrition support. This case highlights the multifaceted nature of CID and the crucial role of early identification, multidisciplinary coordination, and structured dysphagia rehabilitation in enhancing functional outcomes. Instrumental assessments such as FEES and VFSS are key to guiding clinical decisions. With appropriate intervention, patients with CID can achieve meaningful recovery of swallowing function and avoid long-term enteral feeding.