Tracheal Stenosis After Prolonged Intubation Due to COVID-19

Abstract

Objectives We aimed to evaluate the characteristics and management outcomes of patients who developed tracheal stenosis after invasive mechanical ventilation (IMV) due to COVID-19 in this study. Design, settings and participants The data of 7 patients with tracheal stenosis and 201 patients without tracheal stenosis after IMV due to COVID-19 between March 2020 and October 2021 were retrospectively analyzed. Interventions Flexible bronchoscopy was performed for the diagnosis of tracheal stenosis and the evaluation of the treatment's effectiveness and rigid bronchoscopy was applied for the dilatation of tracheal stenosis. Measurements and Main Results In the follow-up period, tracheal stenosis was observed in 7 of 208 patients (2 women, 5 men, 3.3%). The patients were divided into two groups as patients with tracheal stenosis (n=7) and patients without tracheal stenosis (n=201). There was no statistically significant difference between the two groups in terms of age, gender, body mass index (BMI) and comorbidities (p > 0.05). The mean duration of IMV of the patients with tracheal stenosis was longer than patients without tracheal stenosis (27.9 ± 13 vs 11.2 ± 9 days, p < 0.0001, respectively). Three (43%) of the stenoses were web-like and four (57%) of them were complex type stenosis. The mean length of the stenoses was 1.81 ± 0.82 cm. Three of the patients were successfully treated with bronchoscopic dilatation and four of them were treated with tracheal resection. Conclusions Tracheal stenosis developed in 7 (3.3%) of 208 patients with COVID-19 who were treated with IMV. The most important characteristics of patients with tracheal stenosis was prolonged IMV support.

Case Report: Tracheal stenosis due to fibrotic bridges in a post-tracheostomy COVID-19 patient

“…Ayten et al analyzed the incidence of post-invasive mechanical ventilation tracheal stenosis in COVID-19 patients; tracheal stenosis was reported in 7% of patients, and a web-like stenosis was identified in 43% of them. All the simple tracheal stenoses were treated through rigid bronchoscopy, obtaining optimal patency, and showing that rigid bronchoscopy could be an excellent treatment even in simple tracheal stenosis due to invasive mechanical ventilation in COVID-19-related respiratory failure ( 7 ).…”

Management of COVID-19 related tracheal stenosis: The state of art

“…The typical presentation consists of dyspnea, wheezing and stridor on physical examination occurring after several days from extubating (8,9,14). Symptoms may include dysphonia and communication difficulties (22), hoarseness, dry cough, and swallowing problems (12).…”

“…During the pandemic, almost half of COVID-19 patients in ICU required invasive mechanical ventilation, with mean duration of 17 days and high rate of reintubation ( 7 ). The exact number of intubated COVID-19 patients developing TS is unknown, but its incidence is reported to widely range from 3.3% ( 8 ) to 40% ( 9 , 10 ). The raw incidence of TS seems to be higher in COVID-19 patients than in pre-COVID-19 era ( 11 ), and the medical community has been alerted to the possibility of an unprecedented surge in TS ( 12 ), despite the limited number of cases in literature does not allow to draw definitive conclusions in this regard.…”

“…The raw incidence of TS seems to be higher in COVID-19 patients than in pre-COVID-19 era ( 11 ), and the medical community has been alerted to the possibility of an unprecedented surge in TS ( 12 ), despite the limited number of cases in literature does not allow to draw definitive conclusions in this regard. The mean age ranges from 50 ( 13 – 15 ) to 60 ( 8 , 11 , 16 ) years old, and males seem to be more prone to develop this disease, with approximately prevalence of 60%–70% ( 8 , 11 , 13 , 14 , 16 , 17 ).…”

“…The formers include patient's comorbidities, poor health conditions, history of diabetes, lower levels of PaO 2 /FiO 2 and increased hypoxia ( 10 ), obesity, severe inflammation as well as microbial dysregulation of the airways ( 11 , 16 ), COVID-19-related laryngitis and laryngeal edema ( 14 ), disrupted laryngotracheal microcirculation due to prothrombotic and antifibrinolytic state, high viral replication in the tracheal epithelium ( 11 ) leading to viral tracheitis ( 18 ). Instead, the latters consist of iatrogenic lesions during intubation due to poor visibility and chaotic situations, cuff overinflation to avoid aerosol sprays, prolonged intubation, high rate of reintubation, prone position ventilation with movement of the tube, delayed tracheostomy to allow prone position and viral clearance ( 11 ), vasopressor use ( 8 ), high-dose corticosteroid resulting in mucosal atrophy and altered healing, impaired nursing service due to workload of pandemics.…”