Laryngeal oedema associated with <scp>COVID</scp>‐19 complicating airway management

McGrath, Brendan A.; Wallace, Sarah; Goswamy, Jay

doi:10.1111/anae.15092

Cited by 87 publications

(103 citation statements)

References 5 publications

(7 reference statements)

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“…2018, McGrath et al . 2020). Notably, intubation can cause superficial mucosal damage and stiffness, affecting vocal fold pliability required for voicing (Hirano and Kakita 1985).…”

Section: Service Delivery/clinical Implicationsmentioning

confidence: 99%

COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

Patterson

Govender

Roe

et al. 2020

Intl J Lang & Comm Disor

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Background The COVID‐19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high‐risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. Aims To discuss the threats and opportunities from the COVID‐19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. Methods & Procedures The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple‐group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. Main Contribution The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID‐19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non‐instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face‐to‐face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge. Conclusions & Implications The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post‐COVID era to re‐evaluate current practice, embrace opportunities and evaluate new ways of working.

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“…2018, McGrath et al . 2020). Notably, intubation can cause superficial mucosal damage and stiffness, affecting vocal fold pliability required for voicing (Hirano and Kakita 1985).…”

Section: Service Delivery/clinical Implicationsmentioning

confidence: 99%

COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

Patterson

Govender

Roe

et al. 2020

Intl J Lang & Comm Disor

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“…The patients presented in this case series possessed some of the well-described risk factors for the development of post-extubation stridor, specifically prolonged mechanical ventilation (9/9 were >8 days), obesity (6/9 had BMI >26.5), and female gender (7/9) [3]. There was concern that due to pre-existing obesity in many of the COVID-19 patients, along with the use of enhanced personal protective equipment (PPE) for anesthesia teams that there would be an increased incidence of traumatic intubations, another common risk factor for post-extubation stridor [2]. However, it is noteworthy that no traumatic intubations were reported among these patients by the intubating team at our institution.…”

Section: Discussionmentioning

confidence: 99%

“…Post-extubation stridor affects approximately 10% of all critically ill patients and is associated with re-intubation, prolonged duration of mechanical ventilation, and increased need for tracheostomy placement [1]. Patients who require mechanical ventilation to manage the complications of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), appear to have a substantial risk of their clinical course being complicated by post-extubation stridor [2]. In this case series, we present nine patients who required mechanical ventilation for acute respiratory distress syndrome (ARDS) secondary to COVID-19 and later developed post-extubation stridor.…”

Section: Introductionmentioning

confidence: 99%

Post-Extubation Stridor Complicating COVID-19-Associated Acute Respiratory Distress Syndrome: A Case Series

Moran¹,

Godil²,

Goldner³

et al. 2020

Cureus

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Post-extubation stridor is a known complication of mechanical ventilation that affects a substantial number of all critical care patients and leads to increased morbidity and mortality. Common risk factors for the development of post-extubation stridor include female gender, older age, and prolonged length of mechanical ventilation. There may be an increased incidence of post-extubation stridor in patients who require mechanical ventilation to manage the respiratory complications of COVID-19. In this case series, we analyzed nine patients from across our institution who were intubated to manage acute respiratory distress syndrome (ARDS) secondary to COVID-19 and subsequently developed post-extubation stridor. The patients were predominantly females with prolonged intubations and multiple days of prone ventilation. While the patients in this case series possessed some of the well-described risk factors for post-extubation stridor, there may be risk factors specific to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that make these patients more susceptible to the complication. The cuff leak test was performed on the majority of patients in the case series and did not successfully predict successful extubation in this population. Our analysis suggests that prophylactic corticosteroids given in the 24-48 hours prior to elective extubation in female COVID-19 patients who were intubated for more than six days with consecutive days of intermittent prone ventilation may be helpful in reducing the incidence of post-extubation stridor in this population. Overall, this case series elucidates the need for exceptionally close monitoring of COVID-19 patients upon extubation for the development of stridor.

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“…difficult weaning, fistulas etc. During COVID-19 pandemic it becomes even more important for the sudden respiratory distress caused due to thick secretion, poor effort of cough and threatened airway obstruction due to laryngeal edema [10]. Decision for tracheostomy should be taken by multidisciplinary team consisting Surgeon, Intensivist and/or Pulmonologist.…”

Section: Indication Of Tracheostomymentioning

confidence: 99%

A Systematic Review on Tracheostomy in COVID-19 Patients: Current Guidelines and Safety Measures

Mandal

Nandi

Chhebbi

et al. 2020

Indian J Otolaryngol Head Neck Surg

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At this moment the world is fighting with COVID-19 pandemic. Because of increasing number of critical cases, the ICU admissions are also increasing and overwhelming the hospital. These group of patients often required Tracheostomy for proper management and ventilation. As Surgeons we often required to examine and perform procedures in head and neck patients and are in high risk of exposure to aerosol and droplet contamination. We did a literature search for research regarding tracheostomy and its post procedure care during the ongoing COVID-19 pandemic. In this review various international guidelines and sources were put together, and we aim to summarize in a systematic way the available recommendations: indications, timing, technique and safety measures for tracheostomy for COVID-19 patients, from all over the world.

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Laryngeal oedema associated with COVID‐19 complicating airway management

Abstract: We would like to highlight the apparent potential of the SARS-CoV-2 virus in causing airway oedema and laryngitis;

Cited by 87 publications

References 5 publications

COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

COVID‐19 and ENT SLT services, workforce and research in the UK: A discussion paper

Post-Extubation Stridor Complicating COVID-19-Associated Acute Respiratory Distress Syndrome: A Case Series

A Systematic Review on Tracheostomy in COVID-19 Patients: Current Guidelines and Safety Measures

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