Classification of laryngeal injury in patients with prolonged intubation and to determine the factors that cause the injury

Mehel, Dursun Mehmet; Özdemir, Doğukan; Çelebi, Mehmet; Aydemir, Samet; Akgül, Gökhan; Özgür, Abdulkadir

doi:10.1016/j.amjoto.2020.102432

Cited by 21 publications

(23 citation statements)

References 20 publications

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“…Common symptoms of laryngotracheal stenosis include dry cough, hoarseness, swallow dysfunction and at a more advanced stage, stridor. Early diagnosis and treatment of these cases have been shown to yield superior therapeutic outcomes 7 and prevent long-term sequelae. A study of 62 patients from our institution showed that endoscopic surgery can be an effective strategy for definitively treating postintubation tracheal stenosis in most patients.…”

Section: Discussionmentioning

confidence: 99%

“…3 We report a case of COVID-19-related airway stenosis in a patient intubated during the pandemic. Laryngotracheal stenosis, including webs, granulomas and tracheal necrosis, are well-recognised iatrogenic sequelae of prolonged intubation, 7 though bilateral vocal fold fixation is less common. We highlight a safe and effective surgical procedure to relieve airway obstruction from bilateral cricoarytenoid fixation that would ordinarily have required tracheostomy insertion.…”

Section: Introductionmentioning

confidence: 99%

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Emergency presentation of iatrogenic airway stenosis following intubation in a patient with COVID-19 and its management

et al. 2020

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A 59-year-old man presented to the emergency department with recent onset biphasic stridor, dyspnoea and increased work of breathing on the background of prolonged intubation for the novel COVID-19 2 months previously. Flexible laryngoscopy revealed bilateral vocal fold immobility with a soft tissue mass in the interarytenoid region. The patient’s symptoms improved with oxygen therapy, nebulised epinephrine (5 mL; 1:10 000) and intravenous dexamethasone (3.3 mg). The following morning, the patient was taken to theatre, underwent suspension microlaryngoscopy and found to have bilateral fixation of the cricoarytenoid joints and a large granuloma in the interarytenoid area. He underwent cold steel resection of the granuloma and balloon dilatation between the arytenoids, with the hope of mobilising the joints. This failed and CO2 laser arytenoidectomy was performed on the left side. The stridor had resolved postoperatively, with normalisation of work of breathing and the patient was discharged home on the first postoperative day.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emergency presentation of iatrogenic airway stenosis following intubation in a patient with COVID-19 and its management

et al. 2020

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“…However, to the best of our knowledge, no precise description on what happens to the laryngotracheal junction of COVID-19 patients ventilated for prolonged time in prone position has been so far produced. In every case, it is always of utmost importance to diagnose and treat these changes as soon as possible to prevent the stabilization of such conditions into irreversible sequelae [29].…”

Section: Preventive Measures To Avoid Airway Stenosismentioning

confidence: 99%

Long-term intubation and high rate of tracheostomy in COVID-19 patients might determine an unprecedented increase of airway stenoses: a call to action from the European Laryngological Society

Piazza

Filauro

Dikkers

et al. 2020

Eur Arch Otorhinolaryngol

176

192

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Introduction The novel Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, may need intensive care unit (ICU) admission in up to 12% of all positive cases for massive interstitial pneumonia, with possible long-term endotracheal intubation for mechanical ventilation and subsequent tracheostomy. The most common airway-related complications of such ICU maneuvers are laryngotracheal granulomas, webs, stenosis, malacia and, less commonly, tracheal necrosis with tracheo-esophageal or tracheo-arterial fistulae. Materials and methods This paper gathers the opinions of experts of the Laryngotracheal Stenosis Committee of the European Laryngological Society, with the aim of alerting the medical community about the possible rise in number of COVID-19-related laryngotracheal stenosis (LTS), and the aspiration of paving the way to a more rationale concentration of these cases within referral specialist airway centers. Results A range of prevention strategies, diagnostic work-up, and therapeutic approaches are reported and framed within the COVID-19 pandemic context. Conclusions One of the most important roles of otolaryngologists when encountering airway-related signs and symptoms in patients with previous ICU hospitalization for COVID-19 is to maintain a high level of suspicion for LTS development, and share it with colleagues and other health care professionals. Such a condition requires specific expertise and should be comprehensively managed in tertiary referral centers.

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“…This is a dynamic process, and frequent adjustments may be indicated depending on ventilation parameters. Prevention of tracheal mucosal pressure necrosis, resulting tracheal and cricoid chondritis and subsequent stenosis is critical in the SARS‐CoV‐2 population 25,26 …”

Section: Recommendationsmentioning

confidence: 99%

Tracheostomy during SARS‐CoV‐2 pandemic: Recommendations from the New York Head and Neck Society

et al. 2020

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The rapid spread of SARS-CoV-2 in 2019 and 2020 has resulted in a worldwide pandemic characterized by severe pulmonary inflammation, effusions, and rapid respiratory compromise. The result of this pandemic is a large and increasing number of patients requiring endotracheal intubation and prolonged ventilator support. The rapid rise in endotracheal intubations coupled with prolonged ventilation requirements will certainly lead to an increase in tracheostomy procedures in the coming weeks and months. Performing tracheostomy in the setting of active SARS-CoV-2, when necessary, poses a unique situation, with unique risks and benefits for both the patient and the health care providers. The New York Head and Neck Society has collaborated on this document to provide guidance on the performance of tracheostomies during the SARS-CoV-2 pandemic.

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Classification of laryngeal injury in patients with prolonged intubation and to determine the factors that cause the injury

Cited by 21 publications

References 20 publications

Emergency presentation of iatrogenic airway stenosis following intubation in a patient with COVID-19 and its management

Emergency presentation of iatrogenic airway stenosis following intubation in a patient with COVID-19 and its management

Long-term intubation and high rate of tracheostomy in COVID-19 patients might determine an unprecedented increase of airway stenoses: a call to action from the European Laryngological Society

Tracheostomy during SARS‐CoV‐2 pandemic: Recommendations from the New York Head and Neck Society

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