Severe tick-borne encephalitis- weaning and decannulation during intensive care rehabilitation

Background: Tick-borne encephalitis (TBE) can cause severe neurological dysfunction requiring prolonged intensive care. While motor deficits are well recognized, less is known about swallowing and functional outcomes after rehabilitation. Method: This retrospective study included patients with severe TBE discharged from a specialized intensive care rehabilitation center (2019–2024). Functional outcomes were assessed at admission and at discharge, and all times and outcomes reported refer to the inpatient stay at the center. Assessments included the Functional Oral Intake Scale (FOIS; 1–7, ≤3 = tube feeding dependence), Medical Research Council sum score (MRC-SS; 0–60), and Chelsea Critical Care Physical Assessment Tool (CPAx; 0–50). Results: Eighteen patients were included (median age 53 years, 5 women). Median preceding ICU stay was 32 days. At admission to the center, 17/18 required invasive mechanical ventilation and tracheostomy. Median length of stay at the center was 142 days; during this period, 13/17 were weaned and 12/18 decannulated. Significant improvements occurred: FOIS increased from 1 (0–2) to 4.5 (3–6, p=0.0004), MRC-SS from 7 to 21 (p=0.0012), and CPAx from 7.5 to 15.5 (p=0.0014). At discharge, 8/18 had FOIS ≤3, most required hoist transfers, and 5 could perform standing transfers. No deaths occurred. Conclusion: Despite marked limitations in swallowing, strength, and function, most patients with severe TBE could be weaned and decannulated during the inpatient stay at the center. Recovery was slow-moving but accompanied by significant improvements, suggesting that meaningful gains may occur even in severely affected patients during intensive care rehabilitation.