Post-intubation tracheal stenosis after severe COVID-19 infection: A report of two cases

Abstract

Introduction and importance Coronavirus disease 2019 (COVID-19) is a pandemic disease that spread rapidly throughout the world and became a major public health concern. Approximately 5–12% of COVID-19 patients require admission to the intensive-care unit (ICU), where they often require oxygen therapy and prolonged intubation. Post-intubation laryngotracheal stenosis (PILS) is a complication that occurs in 10–22% of non-COVID-19 patients after prolonged intubation, while the rate of COVID-19 related PILS remains unknown. Additionally, there is still no consensus in the literature regarding the management modalities for PILS following COVID-19. Case presentation Here we report two cases of tracheal stenosis after prolonged intubation due to severe COVID-19 infection. The first patient was admitted to the ICU and intubated for 21 days; 3 months after discharge, he developed a 3 cm long tracheal stenosis that narrowed 70% of the lumen. The second patient was intubated for 2 months and, 4 months after discharge, developed a 2.5 cm long tracheal stenosis that narrowed 80% of the lumen. Clinical discussion In both cases, the diagnosis was confirmed by CT scan and Rigid bronchoscopy; then, they were managed successfully with tracheal resection and reconstruction by end-to-end anastomosis. Conclusion In conclusion, we would like to highlight the importance of suspecting PILS in recovered COVID-19 patients re-presenting with breathing difficulties following weaning from mechanical ventilation; therefore, careful follow-up in such patients is required. Moreover, we would like to point out that the management of tracheal stenosis after COVID-19 appears to be similar to that of tracheal stenosis in general.

COVID-19 Patients Presenting with Post-Intubation Upper Airway Complications: A Parallel Epidemic?

“…The true incidence of PITS might be even higher as a number of post-COVID patients may not be referred for dyspnea/tracheal stenosis due to more debilitating COVID-related post-ICU sequelae. Other authors have also observed a similar increase in the incidence of these complications, which could either be attributed to the dramatic increase of intubated patients due to the pandemic or to other factors related to specific patients’ characteristics, to the disease itself, or ultimately to iatrogenic factors related with the hospitalization and the disease management under the current circumstances [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”

“…In a number of case reports, it was highlighted that common post-COVID-19 respiratory symptoms, such as cough and dyspnea after discharge from the hospital, were initially misdiagnosed and later attributed to post-intubation tracheal stenosis [ 27 ]. Prolonged intubation and prone position MV combined with obesity and diabetes have again been recognized as predisposing factors for the development of post-intubation tracheal stenosis in several small case series [ 28 , 29 , 30 , 31 ]. However, Fiacchini G. et al [ 32 ] compared patients with and without COVID-19, all of whom had undergone prolonged (>14 days) MV.…”

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

“…Many papers related to acute and late laryngotracheal complications in COVID-19 patients subjected to invasive mechanical ventilation have been published in the last few months ( Alturk et al, 2021 ; Balakrishnan et al, 2021 ; Fiacchini et al, 2021 ; Mahmood et al, 2021 ; Sandu, 2021 ; Scholfield et al, 2021 ). In order to explain the increase in the incidence of this particular type of complication, several etiopathogenetic hypotheses have been proposed.…”

Impact of pregnancy on airway complications after intubation for COVID-19 infection: A case series

“…Post-intubation LTS is rare with an estimated 4.9 cases per one million individuals per year in the general population [8] . Up to 5 % of non-pregnant adults with COVID-19 infection who required invasive ventilation developed symptomatic post-intubation LTS [9] .…”