Challenges in Recovery: Swallowing and Mobility Issues Post-Diabetes ICU Stay

After being weaned off the ventilator in the intensive care unit, the patient with diabetes is experiencing difficulty swallowing and lack of voluntary movement?

Hello Doctor, my father was hospitalized in January 2018 due to diabetic ketoacidosis (HbA1c 14).
A few days later, he developed pneumonia and was admitted to the intensive care unit, where he was intubated.
The physician determined that he would be unable to breathe independently in the short term, so a tracheostomy was performed.
He was weaned off the ventilator in May 2018 (the tracheostomy tube has not been removed yet) and has been receiving home care since the end of May.
During the course from illness to home care, although he can breathe independently, he has been found to be unable to swallow and walk, and he cannot control his bowel and bladder functions.
Therefore, he has been undergoing rehabilitation (physical and speech therapy).
X-rays and MRIs have shown no embolism in the brain, but a swallow study revealed weakness in the throat muscles, preventing proper function.
After researching, I found a condition called "critical illness polyneuropathy." I am unsure if this is what my father is suffering from.
If so, which department should we consult (we live in central Taiwan)? Besides rehabilitation, what other options are available to help my father recover? Thank you.

Mr. Hong, 30~39 year old female. Ask Date: 2018/10/01

Dr. Hong Weibin reply Neurology

Your father may be suffering from Critical Illness Polyneuropathy, but it is also possible that he has Diabetic Polyneuropathy due to poor diabetes control.
Additionally, it is important to be cautious about potential neuromuscular junction diseases or certain autoimmune diseases that can produce antibodies attacking the body's own tissues, leading to generalized weakness.
Currently, for such conditions, it is advisable to manage blood sugar levels effectively and incorporate rehabilitation.
For diagnosis, seeking assistance from a neurologist is recommended; however, it is currently suggested to consult a specialist in physical medicine and rehabilitation for appropriate rehabilitation arrangements.
Furthermore, in terms of nutrition, consulting a dietitian to ensure adequate protein intake can help promote muscle growth.

Reply Date: 2018/10/01

More Info

The challenges faced by patients recovering from severe illnesses, particularly those with a history of diabetes and complications such as diabetic ketoacidosis, are multifaceted. In your father's case, the combination of prolonged ICU stay, intubation, and subsequent tracheostomy has led to significant issues with swallowing and mobility. These complications are not uncommon in patients who have experienced critical illness, especially those with underlying conditions like diabetes.

Understanding the Challenges:
1. Swallowing Difficulties (Dysphagia): After a prolonged period of intubation or tracheostomy, patients often experience dysphagia, which is the medical term for difficulty swallowing. This can be due to weakness in the muscles responsible for swallowing, which may have been affected by the critical illness or the prolonged immobility. In your father's case, the swallow study indicated muscle weakness in the throat, which is a common issue in patients recovering from critical illness.

2. Mobility Issues: The inability to walk or even sit up independently is another significant challenge. Prolonged bed rest can lead to muscle atrophy and weakness, making it difficult for patients to regain their previous level of mobility. This is compounded in your father's case by the potential for critical illness polyneuropathy, which can occur after prolonged ICU stays and is characterized by weakness and sensory loss.

3. Incontinence: The inability to control urination is also a common issue in patients who have been critically ill, often due to a combination of factors including muscle weakness, neurological impairment, and the effects of medications.

Next Steps for Recovery:
1. Rehabilitation Services: It is crucial to continue with rehabilitation services, including physical therapy and speech therapy. Physical therapy can help improve mobility and strength, while speech therapy is essential for addressing swallowing difficulties. A multidisciplinary approach involving both therapists will provide a comprehensive recovery plan.

2. Neurology Consultation: Given the possibility of critical illness polyneuropathy or diabetic neuropathy, consulting a neurologist may be beneficial. They can perform further evaluations and possibly recommend treatments that could aid in recovery.

3. Nutritional Support: Ensuring adequate nutrition is vital for recovery. A dietitian can help create a meal plan that meets your father's needs, especially if he is struggling with swallowing. They may recommend texture-modified diets or nutritional supplements to ensure he receives adequate calories and nutrients.

4. Monitoring Blood Sugar Levels: Since your father has a history of diabetes, it is essential to monitor his blood sugar levels closely. Poorly controlled diabetes can impede recovery and lead to further complications. Working with an endocrinologist may help optimize his diabetes management.

5. Home Care vs. Nursing Facility: The decision between home care and a nursing facility depends on the level of care your father requires. If he needs intensive rehabilitation and monitoring, a skilled nursing facility may be more appropriate. However, if he can receive adequate support at home, including therapy services, that could also be a viable option.

6. Family Support and Education: Educating family members about the recovery process and how to assist your father can make a significant difference. Understanding the challenges he faces and how to provide support can enhance his recovery experience.

In conclusion, recovery from critical illness, particularly with the complications associated with diabetes, requires a comprehensive and multidisciplinary approach. Engaging with healthcare professionals across various specialties will provide the best chance for your father to regain his independence and improve his quality of life. Regular follow-ups and adjustments to his care plan will be essential as he progresses through his rehabilitation journey.

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