Acquired laryngeal and subglottic stenosis following COVID‐19—Preparing for the coming deluge

Abstract

As the COVID-19 pandemic has swept across the globe, the dominant narrative about overwhelmed inpatient settings obscured a more nuanced crisis-the rising prevalence of occult airway injuries among survivors. Up to 90% of patients admitted to intensive care units undergo intubation and invasive mechanical ventilation, often requiring tracheostomy. Resulting device-related airway pressure injuries are disturbingly common, affecting over 50% of individuals. Endotracheal and tracheostomy tubes may cause a wide range of laryngotracheal injuries, from mucosal ulceration to destruction of cartilage or even transmural injury, causing stenosis-all with profound quality of life ramifications (Brodsky, Akst, et al., 2020;. Nurses are uniquely positioned to expedite diagnosis and intervention, improving voice, swallowing and breathing.

Vía aérea difícil: ¿qué hacer cuando los algoritmos no funcionan?

“…En un adulto, la medida vertical del estacio se encuentra entre 9,3 mm (± 9), y el ancho de 12,3 mm (± 4) [4]. Otro factor, asociado a la presencia de estenosis, es la presión ejercida por el manguito o cuff que conlleva a hipoperfusión del epitelio, necrosis, ulceración y cicatrización fibrosa (granulosa); es por ello que se recomienda que dicha presión no debe superar los 20-30 cm H 2 O [5].…”

“…Se ha convertido en una patología frecuente con el advenimiento de las técnicas de traqueostomía, y la intubación prolongada, debido a requerimiento de ventilación mecánica; y cuya incidencia que se ha elevado en los últimos 2 años como consecuencia directa de la pandemia por SARS-CoV-2. El manejo está determinado según el porcentaje de compromiso del lumen: conservador (< 50%), endoscópico y/o quirúrgico (> 50%) [1]- [5]; con un abordaje anestésico y de manejo de la vía aérea que ponen a prueba el conocimiento y las destrezas de los anestesiólogos más expertos; convirtiendo el entrenamiento en simulación y la revisión académica de los casos; en parte esencial de la formación más allá del posgrado.…”

Tracheal stenosis following mild-to-moderate COVID-19 infection without history of tracheal intubation: a case report

“…Laryngotracheal stenosis is the partial or complete narrowing of the respiratory tract at the larynx, subglottic space, or trachea. The most common site of tracheal stenosis is the subglottic space, as it is the narrowest part of the normal adult airway [ 4 ]. Before the pandemic, laryngotracheal stenosis occurred in up to 9% of patients with invasive mechanical ventilation.…”

Clinical Proof of Concept for Stabilization of Tracheostomy Tubes Using Novel DYNAtraq Device

“… 19 , 20 Consequently, air leaks, alterations in ventilatory flows, increased respiratory work, dyspnea, limitation for weaning from the tracheostomy, decreased quality of life and risk of respiratory infections or late complications (tracheal stenosis) can be observed. 20 , 21 , 22 …”

“…19,20 Consequently, air leaks, alterations in ventilatory flows, increased respiratory work, dyspnea, limitation for weaning from the tracheostomy, decreased quality of life and risk of respiratory infections or late complications (tracheal stenosis) can be observed. 20,21,22 The perception was that in the real clinical environment there was an opportunity for improvement and innovation of a new device for the management and reduction of risks related to tracheostomy tubes, especially their displacement and misalignment. This is very relevant in the ICU setting where mechanical ventilation can be prolonged and associated with serious complications.…”