Tracheal stenosis following mild-to-moderate COVID-19 infection without history of tracheal intubation: a case report

Ershadi, Reza; Rafieian, Shahab; Sarbazzadeh, Javad; Vahedi, Matin

doi:10.1007/s11748-021-01747-6

Cited by 20 publications

(20 citation statements)

References 6 publications

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“…High viral replication in the tracheal epithelium could as well weaken the mucosa. Interestingly, in a recent autopsy study of tracheal epithelial cells, viral particles were found in them [ 33 ], while Ershadi R. et al reported on a case of COVID-19-related tracheal stenosis due viral tracheitis in a patient who had never been intubated [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

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

Stratakos

Anagnostopoulos

Alsaggaf

et al. 2022

JCM

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During the current pandemic, we witnessed a rise of post-intubation tracheal stenosis (PITS) in patients intubated due to COVID-19. We prospectively analyzed data from patients referred to our institution during the last 18 months for severe symptomatic post-intubation upper airway complications. Interdisciplinary bronchoscopic and/or surgical management was offered. Twenty-three patients with PITS and/or tracheoesophageal fistulae were included. They had undergone 31.85 (±22.7) days of ICU hospitalization and 17.35 (±7.4) days of intubation. Tracheal stenoses were mostly complex, located in the subglottic or mid-tracheal area. A total of 83% of patients had fracture and distortion of the tracheal wall. Fifteen patients were initially treated with rigid bronchoscopic modalities and/or stent placement and eight patients with tracheal resection-anastomosis. Post-treatment relapse in two of the bronchoscopically treated patients required surgery, while two of the surgically treated patients required rigid bronchoscopy and stent placement. Transient, non-life-threatening post-treatment complications developed in 60% of patients and were all managed successfully. The histopathology of the resected tracheal specimens didn’t reveal specific alterations in comparison to pre-COVID-era PITS cases. Prolonged intubation, pronation maneuvers, oversized tubes or cuffs, and patient- or disease-specific factors may be pathogenically implicated. An increase of post-COVID PITS is anticipated. Careful prevention, early detection and effective management of these iatrogenic complications are warranted.

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Section: Discussionmentioning

confidence: 99%

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

Stratakos

Anagnostopoulos

Alsaggaf

et al. 2022

JCM

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“…Recently, some Authors (11,15) have described microscopic findings of tracheal samples in COVID-19 patients affected by TS, highlighting patchy coagulative necrosis of the epithelium, granulation tissue, extensive presence of lymphocytes, multinucleated giant cells, nonfistulized abscesses leading to cartilage lysis, as well as thrombotic vessels and lymphocytic microvasculitis. Interestingly, cells with viral cytopathic involvement have been identified (11), and viral particles in tracheal epithelial cells have been detected (24), which could support the pathogenetic role of viral tracheitis theorized by Ershadi and colleagues (18). Moreover, Roncati and colleagues (25) have recently reported, by immunohistochemistry, a high density of IgG4-secreting plasma cells on fibrotic tissue from resected tracheal samples in patients affected by COVID-19-related TS.…”

Section: Pathophysiologymentioning

confidence: 68%

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

Orlandi

Raveglia²,

Calderoni³

et al. 2023

Front. Surg.

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Tracheal stenosis (TS) is a debilitating disease promoted by pathologic narrowing of the trachea. The acute respiratory distress syndrome caused by COVID-19 has been demonstrated to trigger enhanced inflammatory response and to require prolonged invasive mechanical ventilation as well as high frequency of re-intubation or emergency intubation, thus increasing the rate and complexity of TS. The standard-of-care of COVID-19-related tracheal complications has yet to be established and this is a matter of concern. This review aims at collecting latest evidence on this disease, providing an exhaustive overview on its distinctive features and open issues, and investigating different diagnostic and therapeutic strategies to handle COVID-19-induced TS, focusing on endoscopic versus open surgical approach. The former encompasses bronchoscopic procedures: electrocautery or laser-assisted incisions, ballooning dilation, submucosal steroid injection, endoluminal stenting. The latter consists of tracheal resection with end-to-end anastomosis. As a rule, traditionally, the endoscopic management is restricted to short, low-grade, and simple TS, whereas the open techniques are employed in long, high-grade, and complex TS. However, the critical conditions or extreme comorbidities of several COVID-19 patients, as well as the marked inflammation in tracheal mucosa, have led some authors to apply endoscopic management also in complex TS, recording acceptable results. Although severe COVID-19 seems to be an issue of the past, its long-term complications are still unknown and considering the increased rate and complexity of TS in these patients, we strongly believe that it is worth to focus on it, attempting to find the best management strategy for COVID-19-related TS.

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“…Another important take-away regarding airway management during the COVID-19 pandemic was the impact of long-term complications, such as stenosis, that have been seen by the thoracic surgeons. Several etiologies have been proposed to cause these airway complications in COVID-19 patients: tracheal cuff over-inflation, large caliber endotracheal tubes, patient factors such as diabetes, proning maneuvers, high dose steroids, viral replication in respiratory mucosa, prothrombic state, and prolonged hypoxemia (19)(20)(21)(22)(23). These issues may manifest weeks after the COVID-19 infection, consequently some have suggested that all COVID-19 patients should follow with an airway specialist after discharge to facilitate early diagnosis and treatment (19,20).…”

Section: Discussionmentioning

confidence: 99%

Lessons learned by thoracic surgeons during the COVID-19 pandemic

Madsen¹,

Lambert-Kerzner²,

Mucharsky³

et al. 2023

J Thorac Dis

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Background: The scale of the coronavirus disease 2019 (COVID-19) pandemic has necessitated healthcare systems to adapt and evolve, altering physician roles and expectations. Thoracic surgeons have seen practice changes from new COVID-19 consults to necessary delay and triage of elective care. The goal of this study was to understand the impact of COVID-19 on thoracic surgeon experiences in order to anticipate roles and changes in practice in future such circumstances. Methods: Semi-structured, qualitative individual telephone interviews were conducted with thoracic surgeons. Interviews were structured to understand how surgeons were impacted by the COVID-19 pandemic and to record lessons learned. Interviews were conducted until thematic saturation was achieved. Data were analyzed using matrix analysis. Results: Eleven board-certified general thoracic surgeons from nine institutions were interviewed. Thoracic surgeon roles in COVID-19 care included critical care delivery, performing tracheostomies and establishing related protocols, and interventions for long-term airway complications. Attention was called to the impact of the pandemic on thoracic cancer: patients avoided hospitals because of concern over COVID-19, delaying care. Conclusions: Thoracic surgeons played a critical role in the COVID-19 pandemic response in both technical patient care and administrative capacities. Primary care responsibilities included the development, administration and delivery of tracheostomy protocols, and the care of down-stream airway complications. Thoracic surgeons were critical in triage decisions to minimize the impact of COVID-19 on thoracic cancer care. Lessons learned during the COVID-19 pandemic may provide insight into opportunities to promote collaboration in thoracic surgery and facilitate improved care delivery in future settings of resource limitation.

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Tracheal stenosis following mild-to-moderate COVID-19 infection without history of tracheal intubation: a case report

Cited by 20 publications

References 6 publications

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

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

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

Lessons learned by thoracic surgeons during the COVID-19 pandemic

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