Complicated Laryngotracheal Stenosis Occurring Early after COVID-19 Intubation

Abstract

Background: Airway stenosis is a known complication of prolonged intubation in hospitalized patients. With the high rate of intubations in patients with COVID-19 pneumonia, laryngotracheal stenosis (LTS) is a complication of COVID-19 that drastically reduces quality of life for patients who may remain tracheostomy-dependent. Methods: Patient medical history, laryngoscopy, and CT imaging were obtained from medical records. Results: We report four cases of complicated LTS following intubation after COVID-19 pneumonia and explore the current literature in a narrative review. Four patients developed LTS following intubation from COVID-19 pneumonia. Three patients remain tracheostomy-dependent, and the fourth required a heroic operative schedule to avoid tracheostomy. Conclusion: Intubation for COVID-19 pneumonia can result in severe LTS, which may persist despite endoscopic intervention.

Airway Sequelae After Mechanical Ventilation for COVID-19: Protocol for a Scoping Review

“…From those who survived, 95 (55.2%) were followed by video endoscopy at approximately day 100 after extubation; 38 of these patients presented laryngotracheal lesions, resulting in an incidence of 40%, with 6.3% of the cases being severe. The authors suggest that major risk factors for developing laryngotracheal lesions after surviving IMV for severe COVID-19 include larger endotracheal tubes, prone position, duration of intubation, increased leucocyte count, and coagulopathy as determined by elevated D-dimer or PT/INR [ 25 , 26 ]. In addition, widely used pronation maneuvers may increase the chance of laryngotracheal trauma as higher endotracheal pressure may be required, increasing the chances of airway trauma [ 27 ].…”