Post-intubation laryngotracheal stenosis due to COVID 19 in two hospitals
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Abstract
Introduction: COVID-19 infection has left more than 400 million people infected to date, and between 10%-15% require orotracheal intubation. This has triggered a wave of long-term airway sequelae, which have increased post-infectious morbidity and mortality. Objectives: To describe the demographic and clinical characteristics and possible risk factors of patients with laryngotracheal stenosis (LTE) post-intubation by COVID19 at the Hospital Universitario Clínica San Rafael and the Hospital Militar Central in Bogotá, Colombia. Methods: Descriptive observational study of retrospective case series, collecting socio-demographic data, comorbidities, intubation times, stenosis characteristics, results of endoscopic studies, management offered and results. Results: 25 patients were collected, 15 men (60%) and 10 women (40%), with average intubation times of 15.7 days. The most compromised subsites were the trachea (68.2%) and subglottis-trachea (22.7%). Most patients required more than one intervention. Balloon dilation and tracheostomy were the most performed procedures.
Conclusions: LTE is a complication of orotracheal intubation, associated with vasculitis, inflammation and coagulative necrosis of the airway, has increased in cases in severe COVID-19 infection.
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eISSN: 2539-0856
ISSN: 0120-8411
References
World Health Organization (WHO) [Internet]. WHO Coronavirus (COVID-19) Dashboard. 2023 [consultado en marzo de 2022]. Disponible en: https://covid19.who.int/
Fried MP FA. The Larynx. En: The Larynx. San Diego; 2009. p. 85–112.
Rosen CA, Simpson CB. Operative techniques in Laryngology. En: Rosen CA, Simpson CB, editores. Alemania: Springer; 2008.
Minnich DJ, Mathisen DJ. Anatomy of the trachea, carina, and bronchi. Thorac Surg Clin. 2007;17(4):571-85. doi: 10.1016/j. thorsurg.2006.12.006
Furlow PW, Mathisen DJ. Surgical anatomy of the trachea. Ann Cardiothorac Surg. 2018;7(2):255-60. doi: 10.21037/ acs.2018.03.01
Filauro M, Mazzola F, Missale F, Canevari FR, Peretti G. Endoscopic Preoperative Assessment, Classification of Stenosis, Decision-Making. Front Pediatr. 2020;7:532. doi: 10.3389/fped.2019.00532
Smith MM, Cotton RT. Diagnosis and management of laryngotracheal stenosis. Expert Rev Respir Med. 2018;12(8):709-17. doi: 10.1080/17476348.2018.1495564
Monnier P. Pediatric Airway Surgery. 3.a edición. Alemania: Springer; 2011. p. 183-324.
Rosow DE, Barbarite E. Review of adult laryngotracheal stenosis: pathogenesis, management, and outcomes. Curr Opin Otolaryngol Head Neck Surg. 2016;24(6):489-93. doi: 10.1097/ MOO.0000000000000305
Schweiger C, Manica D. Acute laryngeal lesions following endotracheal intubation: Risk factors, classification and treatment. Semin Pediatr Surg. 2021;30(3):151052. doi: 10.1016/j.sempedsurg.2021.151052
Piazza C, Filauro M, Dikkers FG, Nouraei SAR, Sandu K, Sittel C, et al. Long-term intubation and high rate of tracheostomy in COVID-19 patients might determine an unprecedented increase of airway stenoses: a call to action from the European Laryngological Society. Eur Arch Otorhinolaryngol. 2021;278(1):1-7. doi: 10.1007/s00405-020-06112-6
Allgood S, Peters J, Benson A, Maragos C, McIltrot K, Slater T, et al. Acquired laryngeal and subglottic stenosis following COVID-19-Preparing for the coming deluge. J Clin Nurs. 2021:10.1111/jocn.15992
Alturk A, Bara A, Darwish B. Post-intubation tracheal stenosis after severe COVID-19 infection: A report of two cases. Ann Med Surg (Lond). 2021;67:102468. doi: 10.1016/j. amsu.2021.102468
Naunheim MR, Zhou AS, Puka E, Franco RA Jr, Carroll TL, Teng SE, Mallur PS, Song PC. Laryngeal complications of COVID-19. Laryngoscope Investig Otolaryngol. 2020;5(6):1117-124. doi: 10.1002/lio2.484
Scholfield DW, Warner E, Ahmed J, Ghufoor K. Subglottic and tracheal stenosis associated with coronavirus disease 2019. J Laryngol Otol. 2021;135(7):656-58. doi: 10.1017/ S0022215121001134.
Thong G, Lorenz H, Sandhu GS, AlYaghchi C. Emergency presentation of iatrogenic airway stenosis following intubation in a patient with COVID-19 and its management. BMJ Case Rep. 2020;13(12):e238508. doi: 10.1136/bcr-2020-238508
Pandian V, Brodsky MB, Brigham EP, Parker AM, Hillel AT, Levy JM, et al. COVID-19 survivorship: How otolaryngologist head and neck surgeons can restore quality of life after critical illness. Am J Otolaryngol. 2021;42(3):102917. doi: 10.1016/j. amjoto.2021.102917
Azevedo I, Figueroa PU. Commentary: Should surgeons challenge the unknown sequela of the coronavirus disease 2019 (COVID-19) virus? JTCVS Tech. 2020;4:366-67. doi: 10.1016/j.xjtc.2020.09.027
Ünlü S, Ilgar M, Akçiçek M. The evaluation of the trachea as a new parameter in determining the prognosis of COVID-19: first pilot study. Eur Rev Med Pharmacol Sci. 2021;25(14):4835- 840. doi: 10.26355/eurrev_202107_26397
Torretta S, Gaini LM, Gaffuri M, Pignataro L, Accorona R, Capaccio P. Looking at the day after COVID-19… what laryngeal sequelae should we expect? Acta Otorhinolaryngol Ital. 2020;40(6):466-68. doi: 10.14639/0392-100X-N0884
Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417- 418. doi: 10.1016/S0140-6736(20)30937-5
Dominguez LM, Simpson CB. Viral laryngitis: a mimic and a monster - range, presentation, management. Curr Opin Otolaryngol Head Neck Surg. 2015;23(6):454-8. doi: 10.1097/ MOO.0000000000000203
Das A, Roy S, Swarnakar S, Chatterjee N. Understanding the immunological aspects of SARS-CoV-2 causing COVID-19 pandemic: A therapeutic approach. Clin Immunol. 2021;231:108804. doi: 10.1016/j.clim.2021.108804
Oliver CM, Campbell M, Dulan O, Hamilton N, Birchall M. Appearance and management of COVID-19 laryngo-tracheitis: two case reports. F1000Res. 2020;9:310. doi: 10.12688/ f1000research.23204.2
Miwa M, Nakajima M, H Kaszynski R, Hamada S, Nakano T, Shirokawa M, et al. Two Cases of Post intubation Laryngotracheal Stenosis Occurring after Severe COVID-19. Intern Med. 2021;60(3):473-77. doi: 10.2169/ internalmedicine.6105-20
Fiorelli S, Menna C, Massullo D, Rendina EA. Managing benign tracheal stenosis during COVID-19 outbreak. Gen Thorac Cardiovasc Surg. 2021;69(2):412-13. doi: 10.1007/ s11748-020-01466-4
Mangalmurti N, Hunter CA. Cytokine Storms: Understanding COVID-19. Immunity. 2020;53(1):19-25. doi: 10.1016/j. immuni.2020.06.017
Mattioli F, Marchioni A, Andreani A, Cappiello G, Fermi M, Presutti L. Post-intubation tracheal stenosis in COVID-19 patients. Eur Arch Otorhinolaryngol. 2021;278(3):847-48. doi: 10.1007/s00405-020-06394-w
Lucchi M, Ambrogi M, Aprile V, Ribechini A, Fontanini G. Laryngotracheal resection for a post-tracheotomy stenosis in a patient with coronavirus disease 2019 (COVID-19). JTCVS Tech. 2020;4:360-64. doi: 10.1016/j.xjtc.2020.08.023