Laryngotracheal stenosis following intubation and tracheostomy for COVID-19 pneumonia: a case report

Abstract

Laryngotracheal stenosis (LTS) is a rare but serious condition characterized by narrowing of the airway. Iatrogenic injury from endotracheal intubation or tracheostomy insertion is the most common cause of LTS. We present the first reported experience of managing a patient diagnosed with subglottic stenosis (a subtype of LTS) following previous intubation and tracheostomy for coronavirus disease 2019 (COVID-19). This patient required an urgent surgical tracheostomy and subsequent referral to a tertiary airway surgery unit for definitive treatment, which included microlaryngoscopy, laser excision and balloon dilatation. This case highlights that LTS should be included in the differential diagnosis for patients re-presenting with breathing difficulties after prolonged intubation or tracheostomy for COVID-19. Furthermore, it raises the concern of a rise in the incidence of this condition and an increased burden on the few units specializing in airway surgery.

Long‐term upper aerodigestive sequelae as a result of infection with COVID‐19

“…However, only the clinical diagnosis of granuloma was found to be statistically significant upon comparison between the two cohorts. These results are consistent with data presented in recent literature demonstrating the prevalence of patients with a history of severely prolonged intubation as a consequence of COVID‐related pneumonia who have presented with advanced stenotic airway lesions 12,17,22,23 …”

“…These results are consistent with data presented in recent literature demonstrating the prevalence of patients with a history of severely prolonged intubation as a consequence of COVID-related pneumonia who have presented with advanced stenotic airway lesions. 12,17,22,23 The etiology of these laryngeal manifestations may be the inflammatory nature of COVID-19 infections or the intubation itself. The upper aerodigestive tract has long been considered to be part of a unified airway with the lower respiratory tract, the latter being the primary target of SARS-CoV-2.…”

A Novel Approach to Repair of Tracheal Occlusion Secondary to Percutaneous Tracheostomy Creation

“…Patients with post-intubation tracheal stenosis or occlusion are often referred for tracheal resection, but this may not be ideal in frail patients or centers without expertise in tracheal surgery. The first case report of a patient who developed laryngotracheal stenosis following intubation and tracheostomy due to COVID-19 pneumonia was managed with microlaryngoscopy, laser excision, and balloon dilation [8].…”

“…Patients with post-intubation tracheal stenosis or occlusion are often referred for tracheal resection, but this may not be ideal in frail patients or centers without expertise in tracheal surgery. The first case report of a patient who developed laryngotracheal stenosis following intubation and tracheostomy due to COVID-19 pneumonia was managed with microlaryngoscopy, laser excision, and balloon dilation [ 8 ]. In the last month, we have seen a case series regarding a bronchoscopic retrograde recanalization approach of a similar set of pathologies, this shows that our novel approach has the potential to become pervasive [ 9 ].…”

An International Commentary on Dysphagia and Dysphonia During the COVID-19 Pandemic

“…Intubation duration is an established risk factor for dysphagia [ 61 , 63 ]. The longer intubation times associated with COVID-19 increase the risk of laryngeal sequelae, including the need for tracheostomy, dysphagia, vocal fold paralysis, dysphonia, edema, and laryngeal-tracheal stenosis [ 66 , 68 ]. Laryngeal injury may be caused by intubation trauma, the mechanical pressure/mucosal irritation by the endotracheal tube (ETT), and disuse atrophy (Fig.…”