Incidence and types of laryngotracheal sequelae of prolonged invasive ventilation in COVID-19 patients

Abstract

Purpose The COVID-19 outbreak has led to an increasing number of acute laryngotracheal complications in patients subjected to prolonged mechanical ventilation, but their incidence in the short and mid-term after ICU discharge is still unknown. The main objective of this study is to evaluate the incidence of these complications in a COVID-19 group of patients and to compare these aspects with non-COVID-19 matched controls. Methods In this cohort study, we retrospectively selected patients from November 1 to December 31, 2020, according to specific inclusion and exclusion criteria. The follow-up visits were planned after 6 months from discharge. All patients were subjected to an endoscopic evaluation and completed two questionnaires (VHI-10 score and MDADI score). Results Thirteen men and three women were enrolled in the COVID-19 group while nine men and seven women were included in the control group. The median age was 60 [56–66] years in the COVID-19 group and 64 [58–69] years in the control group. All the patients of the control group showed no laryngotracheal lesions, while five COVID-19 patients had different types of lesions, two located in the vocal folds and three in the trachea. No difference was identified between the two groups regarding the VHI-10 score, while the control group showed a significantly worse MDADI score. Conclusions COVID-19 patients subjected to prolonged invasive ventilation are more likely to develop a laryngotracheal complication in the short and medium term. A rigorous clinical follow-up to allow early identification and management of these complications should be set up after discharge.

Laryngotracheal Complications after Intubation for COVID-19: A Multicenter Study

“…Subglottic stenosis, laryngeal mucosa ulceration, and glottic granulomas have also been frequently observed and may be a consequence of this injury to the base mucosa, the number of days of intubation, or the size of the tube, as described in other studies [ 11 , 27 , 29 , 35 , 36 , 37 , 38 , 39 , 40 ]. The laryngotracheal complications can derivate in fibrosis with secondary arytenoid ankylosis and laryngeal movement impairment.…”

“…In our study, tracheostomy was delayed in 100% of cases (beyond 7 days) with an average of 16.35 days. This could be one of the hypotheses for the appearance of more lesions after intubation in this type of patient than in others intubated for another pathology in other periods outside the COVID-19 pandemic ( Table 6 ) [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 23 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ].…”

Fatal Asphyxia Potentially Caused by COVID-19-Induced Exacerbation of Pre-existing Tracheal Stenosis

“…Tracheal stenosis is the main side effect among patients with COVID-19 undergoing tracheal intubation [ 1 ]. To our knowledge, only one case of tracheal stenosis has been reported in a patient with COVID-19 who did not undergo tracheal intubation [ 2 ].…”

Risk of Post-Intubation Laryngotracheal Stenosis With Respect to COVID-19 Status in a Large Multicenter Cohort Cross-Sectional Study

“…For example, Félix et al ( 6 ) reported a 17% occurrence ( n = 16/95) and Ayten et al ( 7 ) reported a 3.3% occurrence ( n = 7/208) of post-intubation LTS in COVID-19 patients. Two studies compared the occurrence of post-intubation LTS in COVID-19 positive and negative cohorts, with group sizes ranging from 16 to 45 patients ( 4 , 8 ). Fiacchini et al ( 8 ) reported a 5% occurrence ( n = 8/16) of LTS in the COVID-19 positive cohort vs. 0% occurrence ( n = 0/16) of LTS in a case-controlled COVID-19 negative cohort.…”

“…Two studies compared the occurrence of post-intubation LTS in COVID-19 positive and negative cohorts, with group sizes ranging from 16 to 45 patients ( 4 , 8 ). Fiacchini et al ( 8 ) reported a 5% occurrence ( n = 8/16) of LTS in the COVID-19 positive cohort vs. 0% occurrence ( n = 0/16) of LTS in a case-controlled COVID-19 negative cohort. In another study by the Fiacchini et al ( 4 ) group, they observed a 47% occurrence of full-thickness tracheal lesions and tracheoesophageal fistulas in the COVID-19 positive ( n = 14/30) vs. 2.2% in the COVID-19 negative (1/45) cohorts.…”