Post-intubation subglottic stenosis: aetiology at the cellular and molecular level

Abstract

Subglottic stenosis (SGS) is a narrowing of the airway just below the vocal cords. This narrowing typically consists of fibrotic scar tissue, which may be due to a variety of diseases. This review focuses on post-intubation (PI) SGS. SGS can result in partial or complete narrowing of the airway. This narrowing is caused by fibrosis and can cause serious breathing difficulties. It can occur in both adults and children. The pathogenesis of post-intubation SGS is not well understood; however, it is considered to be the product of an abnormal healing process. This review discusses how intubation can change the local micro-environment, leading to dysregulated tissue repair. We discuss how mucosal inflammation, local hypoxia and biomechanical stress associated with intubation can promote excess tissue deposition that occurs during the pathological process of SGS.

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

“…Acute laryngeal injury may occur much more often in patients with diabetes and larger body habitus or those who receive prolonged mechanical ventilation and an endotracheal tube greater than size 7.0 [ 18 ]. Nevertheless, it seems that the incidence of iatrogenic tracheal stenoses was much higher in the past and that the use of endotracheal tubes with low-pressure/high-volume cuffs did reduce the occurrence of this complication, although this still largely depends on the quality of the provided medical and nursing care [ 9 , 19 , 20 ].…”

“…All the above, even if histopathology did not reveal specific alterations, could potentially be attributed to a type of viral tracheitis. This, in the presence of other confounding factors either related to patients’ or management’s characteristics, could produce the observed airway damage [ 20 ]. In a recent histopathology report, a high localized density of IgG4 immunoglobulins-secreting plasma cells were found inside the fibrotic tissue of resected tracheal rings after post-COVID-19 PITS [ 38 ].…”

Unintended Consequences of An Analog Fix in A Digital Era: Transport Ventilators Associated with Significantly Longer Duration of Intubation for Critically Ill COVID-19 Patients

“…However, signi cant mortality exists for older patients, and those with a greater comorbid burden [21,22]. In addition, there has been an observed increased incidence of post-intubation tracheal stenosis in COVID-19 patients, with a suspected pathophysiologic relationship secondary to prolonged mechanical ventilation, hypoxia, and in ammation [23]. We did observe an increase in days of intubation, thus increasing the probability of complications due to prolonged intubation.…”

Impact of pregnancy on airway complications after intubation for COVID-19 infection: A case series

“…Up to 5 % of non-pregnant adults with COVID-19 infection who required invasive ventilation developed symptomatic post-intubation LTS [9] . Risk factors for LTS include traumatic intubation, multiple intubations, large endotracheal tube size, and superimposed infection, with duration of intubation considered the most significant factor [4] . Additional risk factors include smoking, obesity, diabetes, female gender, and elevated levels of estrogen, which places pregnant patients at a higher risk of developing this complication [5] .…”

“…Risk factors for LTS include traumatic intubation, multiple intubations, and endotracheal tube size. The duration of intubation is the most important risk factor in adults and children [4] . Additional risk factors include female gender and elevated levels of estrogen [5] .…”