Post-COVID-19 airway stenosis treated by tracheal resection and anastomosis: a bicentric experience

Abstract

SUMMARY Objective The COVID-19 pandemic was an extraordinary challenge for the global healthcare system not only for the number of patients affected by pulmonary disease, but also for the incidence of long-term sequalae. In this regard, laryngo-tracheal stenosis (LTS) represents one of the most common complications of invasive ventilation. Methods A case series of patients who underwent tracheal resection and anastomosis (TRA) for post-COVID-19 LTS was collected from June 2020 to September 2021. Results Among 14 patients included, 50% had diabetes and 64.3% were obese. During intensive care unit stay, mean duration of orotracheal intubation (OTI) was 15.2 days and 10 patients (71.4%) underwent tracheostomy, which was maintained in 7 for an average of 31 days. According to the European Laryngological Society classification, 13 patients (92.9%) had a grade IIIa LTS and one a grade IIIa+. All patients underwent Type A TRA, according to the authors’ classification. No major perioperative complications were reported and at the last follow-up all patients were asymptomatic. Conclusions With the appropriate indications, TRA represents an effective treatment in post-COVID-19 LTS patients. Short OTI times and careful tracheostomy are required in order to reduce the incidence of airway injury.

Cricotracheostomy for patients with severe COVID-19: A case control study

“…Additionally, the rate of infection transmission to healthcare workers during tracheostomy is extremely low when appropriate personal protective equipment is used (19). It has also been reported that tracheostomy at appropriate timing should be considered to avoid laryngotracheal stenosis (20)(21)(22)(23)(24).…”

Achieving Successful Extubation and Cost-Effective Recovery Following Anesthetic Airway Management in Supracarinal Tracheal Reconstruction Surgeries: A Retrospective Analysis

“…The most common reason for tracheal stenosis observed was prolonged mechanical ventilation and tracheostomy (PITS) [ 24 ]. The patients who had PITS had various etiologies, such as head injury, urosepsis, organic phosphorous poisoning, post-tracheostomy following extensive facial-maxillary surgery, and post-COVID-19 recovery [ 7 , 8 ].…”

“…Among all the patients who underwent tracheal reconstruction surgeries at our tertiary care center, the major cause of tracheal stenosis was post-intubation tracheal stenosis (PITS) [ 7 , 8 ]. PITS patients were referred from different hospitals with various etiological factors during the pre-coronavirus disease 2019 (COVID-19) and post-COVID-19 periods.…”

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).…”

“…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 ).…”