Two Cases of Post-intubation Laryngotracheal Stenosis Occurring after Severe COVID-19

Miwa, Maki; Nakajima, Mikio; Kaszynski, Richard H.; Hamada, Syoichiro; Nakano, Tomotsugu; Shirokawa, Masamitsu; Goto, Hideaki; Yamaguchi, Yoshihiro

doi:10.2169/internalmedicine.6105-20

Cited by 28 publications

(23 citation statements)

References 14 publications

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“…PILS becomes symptomatic (1–2% of cases) when the stenosis includes >60% of the tracheal lumen. Previous reports showed that the time of onset of PILS varied from 28 days to 6 months after extubation [ 3 ]. The most common cause of PILS is iatrogenic [ 7 ], specifically in prolonged intubations, endotracheal tube cuff hyperinflation, and the usage of large tubes.…”

Section: Discussionmentioning

confidence: 99%

“…However, the global trend for COVID-19 patients admitted to ICU is to postpone tracheostomy until the patient no longer needs mechanical ventilation and is cleared of the virus; this delay is mainly due to the high risk of cross-infection of healthcare professionals [ 6 ]. Early reports state that COVID-19 patients remained intubated from one to two weeks or longer [ 3 ]. In our case, one patient underwent 3 weeks and the other 8 weeks of mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…Most COVID-19 patients present with minor symptoms like fever, cough, fatigue, headache, new loss of taste or smell, sore throat, nausea, and gastrointestinal symptoms [ 2 ]. In a low number of patients, the disease may take a severe form with serious complications, including interstitial pneumonia, acute respiratory failure, acute respiratory distress syndrome (ARDS), multiple organ failure, and death [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…While tracheal intubation is a life-saving procedure, it may cause mucosal damage and tracheal wall necrosis, which leads to laryngotracheal stenosis [ 4 ]. The rate of post-intubation laryngotracheal stenosis (PILS) in non-COVID-19 patients is 10–22% [ 3 ]. Although the rate of COVID-19 related PILS remains unknown, it is thought that this complication is more common in COVID-19 patients after prolonged tracheal intubation [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The rate of post-intubation laryngotracheal stenosis (PILS) in non-COVID-19 patients is 10–22% [ 3 ]. Although the rate of COVID-19 related PILS remains unknown, it is thought that this complication is more common in COVID-19 patients after prolonged tracheal intubation [ 3 ]. On top of that, the choice of the modality of management of these patients is still undetermined.…”

Section: Introductionmentioning

confidence: 99%

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

Alturk

Bara

Darwish

2021

Annals of Medicine &Amp; Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Alturk

Bara

Darwish

2021

Annals of Medicine &Amp; Surgery

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POSTN Regulates Fibroblast Proliferation and Migration in Laryngotracheal Stenosis Through the TGF‐β/RHOA Pathway

She,

Chen,

Lin

et al. 2024

The Laryngoscope

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ObjectivesTo investigate the role of periostin (POSTN) and the transforming growth factor β (TGF‐β) pathway in the formation of laryngotracheal stenosis (LTS) scar fibrosis and to explore the specific signaling mechanism of POSTN‐regulated TGF‐β pathway in tracheal fibroblasts.MethodsBioinformatics analysis was performed on scar data sets from the GEO database to preliminarily analyze the involvement of POSTN and TGF‐β pathways in fibrosis diseases. Expression of POSTN and TGF‐β pathway‐related molecules was analyzed in LTS scar tissue at the mRNA and protein levels. The effect of POSTN on the biological behavior of tracheal fibroblasts was studied using plasmid DNA overexpression and siRNA silencing techniques to regulate POSTN expression and observe the activation of TGF‐β1 and the regulation of cell proliferation and migration via the TGF‐β/RHOA pathway.ResultsThe bioinformatics analysis revealed that POSTN and the TGF‐β pathway are significantly involved in fibrosis diseases. High expression of POSTN and TGF‐β/RHOA pathway‐related molecules (TGFβ1, RHOA, CTGF, and COL1) was observed in LTS tissue at both mRNA and protein levels. In tracheal fibroblasts, overexpression or silencing of POSTN led to the activation of TGF‐β1 and regulation of cell proliferation and migration through the TGF‐β/RHOA pathway.ConclusionPOSTN is a key molecule in scar formation in LTS, and it regulates the TGF‐β/RHOA pathway to mediate the formation of cicatricial LTS by acting on TGF‐β1. This study provides insights into the molecular mechanisms underlying LTS and suggests potential therapeutic targets for the treatment of this condition.Level of EvidenceNA Laryngoscope, 2024

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Type and morphology affect the success rate of bronchoscopy for postintubation tracheal stenosis

Yang,

Li,

Zhou

et al. 2024

Laryngoscope Investig Oto

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ObjectiveWith advancements in respiratory interventional techniques, bronchoscopic intervention technology has emerged as a viable approach for managing postintubation tracheal stenosis (PITS). However, there was a paucity of research investigating the potential impact of stenosis characteristics and morphology (such as stenosis degree, length, type, and morphology) on bronchoscopic intervention treatment prognosis for PITS patients. This study was to assess the impact of various preoperative stenosis characteristic factors on the bronchoscopic cure rate among patients.MethodsThis is a retrospective study analyzing the medical records of patients with PITS who received bronchoscopic intervention at the tertiary interventional pulmonology center.ResultsAmong the cases, 115 individuals achieved a in a success rate of 79.86% for bronchoscopic intervention therapy and were assigned to Group S. On the other hand, 29 cases required surgical intervention, accounting for a surgical treatment rate of 20.14% and were assigned to Group F. The stenosis in the Group F predominantly exhibited irregular shapes with scar granulation accompanied by tracheal chondromalacia collapse. Patients in group S experienced fewer total procedures, rigid bronchoscopy treatment, intraoperative hypoxemia, needed emergency re‐bronchoscopy in 24 h and transferred to ICU postoperatively. Patients with pure scar and granuloma, the rate of bronchoscopic success cure was higher than patients with scar granulation accompanied by tracheal chondromalacia (odds ratio: 8.208; 95% confidence interval: 2.755–24.459), and regular stenosis morphology was associated with a higher bronchoscopic success cure rate (odds ratio: 9.463; 95% confidence interval: 3.128–28.623).ConclusionIrregular airway stenosis, chondromalacia or airway collapse are key factors affecting the success rate of bronchoscopic treatment for post‐intubation tracheal stenosis.Level of evidence: 4 (historically controlled studies).

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Two Cases of Post-intubation Laryngotracheal Stenosis Occurring after Severe COVID-19

Cited by 28 publications

References 14 publications

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

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

POSTN Regulates Fibroblast Proliferation and Migration in Laryngotracheal Stenosis Through the TGF‐β/RHOA Pathway

Type and morphology affect the success rate of bronchoscopy for postintubation tracheal stenosis

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