Introduction
Many patients who underwent prolonged intubation [1] develop
dysphagia after extubation, with an occurrence varying between 3% and
62%. The prevalence of swallowing disorders increases as the intubation
period is extended [2]. Dysphagia predisposes to prolonged
hospitalizations and to a worse prognosis due to the high risk of
complications such as aspiration pneumonia, malnutrition and
dehydration. The origin of post-intubation dysphagia derives from
several factors: the endotracheal tube can cause trauma at pharynx or
larynx [1] and can generate muscle atrophy due to disuse, aggravated
by long sedation and the use of neuromuscular blockers. Such disuse of
the swallowing mechanism may diminish its cortical representation and
delay functional recovery in the long term. To these factors can be
added changes in sensitivity, gastroesophageal reflux and
breath-swallowing incoordination [3]. Recovery after post-intubation
dysphagia is usually possible in a short period of time [2]. In
patients with Acute Respiratory Distress Syndrome (ARDS), however,
swallowing improvement appears slower, even longer than 6 months. The
reason may lie in the severity of the pathology that often requires
prolonged mechanical ventilation and long stays in intensive care unit.
A recent case-control study compared the trend of swallowing disorders
after endotracheal tube removal in 101 Covid-19 patients and in 150
non-Covid-19 patients undergoing prolonged intubation. Although Covid-19
patients were intubated longer, they showed less swallowing disorders
after extubation and required fewer re-education sessions [4].
However, there is no data about the incidence of dysphagia in these
patients also owing to the reduction of diagnostic procedures such as
Fiberoptic Endoscopic Evaluation of Swallowing (FEES) during Covid-19
pandemic because of the aerosol generating risk [5]. In May 2020 the
first case report on oropharyngeal dysphagia associated with Sars-CoV-2
was published: the patient, a 70-year-old man, after an 11-day
intubation developed dysphagia and a subsequent aspiration pneumonia.
The instrumental evaluations evidenced bilateral absent GAG reflex,
pyriform and vallecular salivary stagnation and silent aspiration. The
patient received rehabilitative treatment with noticeable improvement of
symptoms, without the need for nasogastric tube or Percutaneous
Endoscopic Gastrostomy (PEG) positioning. The authors hypothesized the
presence of a glossofaringeal and vagal neuropathy underlying the
development of dysphagia [6]. Another newest Italian case report
highlighted the possible involvement of the cranial nerves in dysphagia
development during Covid-19 [7].
The purpose of the present case report is to describe the clinical
history and the rehabilitation of a patient coming from Bergamo, Italy.
Patient’s informed consent was obtained for data treatment.