Inflammatory Profiles of Tracheal Biopsies From SARS-CoV-2 Patients

Abstract

PurposeAn increasing number of laryngotracheal complications in mechanically ventilated COVID-19 patients has been reported in the last few months. Many etiopathogenetic hypotheses were proposed but no clear explanation of these complications was identified. In this paper we evaluated the possibility that the tracheal mucosa could be a high viral replication site that could weaken the epithelium itself.MethodsSubjects for the COVID-19 group and the control group were selected retrospectively according to specific criteria. Patients’ basic and clinical data were recorded and analyzed. Tracheal samples of both groups were collected during surgical tracheostomies and then analyzed from a histological and genetic-transcriptional point of view.ResultsFour COVID-19 patients were enrolled in this study and compared with four non-COVID-19 patients. No laryngotracheal complications were identified in both groups. The SARS-CoV-2 was detected in one out of four COVID-19 samples. A subepithelial inflammatory lymphomonocyte infiltrate was observed in all patients but two cases of the COVID-19 group showed vasculitis of small subepithelial vessels associated with foci of coagulative necrosis. Two gene sets (HALLMARK_INFLAMMATORY_RESPONSE and HALLMARK_ESTROGEN_RESPONSE_LATE) were significantly deregulated in COVID-19 patients compared to the control group.ConclusionThe altered inflammatory response of the COVID-19 patients could be another possible explanation of the increasing number of laryngotracheal complications.

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

“…Specifically, by moving the patient from the supine to the prone position, the orotracheal tube cuff is supposed to increase its pressure on the tracheal walls, thus causing tissue lesions [ 23 ]. Other possible etiopathogenetic causes could be the high cuff pressure, the use of large caliber tubes, the microvascular injury of laryngo-tracheal mucosa caused by the prothrombotic and antifibrinolytic state of these patients, the use of high dose systemic steroids, the high viral replication within the laryngotracheal mucosa which could weaken the epithelium itself [ 24 ], or unreported mistakes or accidents by physically and emotionally exhausted health care professionals [ 25 ]. However, to date, it must be specified that none of these hypotheses has been confirmed.…”

Endoscopic Management of Benign Airway Stenosis in Coronavirus Disease 2019 Patients

“…In theory, the high viral replication in the tracheal epithelium of patients with active infection could weak the mucosa and facilitate the re-growth of stenotic scar after endoscopic dilatation. Fiacchini et al [17] found higher rate of tracheal complications including LTS in COVID-19 patients undergone prolonged intubation compared to control group, implying a possible role for microbial inflammation in the pathogenesis of these lesions. Ershadi et al [18] reported a case of LTS due to viral tracheitis in a COVID-19 patient who had never been intubated.…”