Post-intubation tracheal stenosis in COVID-19 patients

Mattioli, Francesco; Marchioni, Alessandro; Andreani, Alessandro; Cappiello, Gaia; Fermi, Matteo; Presutti, Livio

doi:10.1007/s00405-020-06394-w

Cited by 48 publications

(55 citation statements)

References 7 publications

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“…Although Mr. Francesco Mattioli et al [ 9 ] suggested managing tracheal stenosis that occurs after COVID-19 endoscopically with balloon dilation and local corticosteroid injection, which maintains an adequate airway that enables breathing for an acceptable period, he mentioned that this procedure could be temporary, and other procedures may be needed later; probably tracheal resection and reconstruction, as we did to our patients, who were both suitable for surgery. In another paper [ 7 ], Mr. Carmine Fernando Gervasio et al reported managing two cases of tracheal stenosis following COVID-19: one with intravenous corticosteroids, while the other with tracheal resection.…”

Section: Discussionmentioning

confidence: 88%

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: 88%

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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“…129 Vocal cord injuries, subglottic stenosis, and tracheomalacia have all been described. [130][131][132][133] Depending on the severity of respiratory/airway sequelae and type of surgery, use of supraglottic airway devices should be considered and offered to individuals on case-by-cases basis. Furthermore, given reports of significant fibrosis and bullae, lung protective ventilation is strongly encouraged with tidal volumes 4-8 cc/kg of predicted body weight, and driving pressures <15 cm H 2 O.…”

Section: Pulmonarymentioning

confidence: 99%

Post-Acute COVID-19 Syndrome for Anesthesiologists: A Narrative Review and a Pragmatic Approach to Clinical Care

Kopanczyk

Kumar

Papadimos

2022

Journal of Cardiothoracic and Vascular Anesthesia

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Post-acute coronavirus disease 2019 (COVID-19) syndrome is a novel, poorly understood clinical entity with life-impacting ramifications. Patients with this syndrome, also known as “ COVID-19 long-haulers ,” often present with non-specific ailments involving more than one body system. The most common complaints include dyspnea, fatigue, brain fog, and chest pain. There is currently no single agreed-upon definition for post-acute COVID-19 syndrome, but most agree that criterion for this syndrome is the persistence of mental and physical health consequences after initial infection. Given the millions of acute infections in the U.S. over the course of the pandemic, perioperative providers will encounter these patients in clinical practice in growing numbers. Symptoms of the COVID-19 long-haulers should not be minimized as these patients are at higher risk for postoperative respiratory complications and perioperative mortality for up to 7 weeks after initial illness. Instead, a cautious multidisciplinary preoperative evaluation should be performed. Perioperative care should be viewed through the prism of best practices already in use such as avoidance of benzodiazepines in patients with cognitive impairment and use of lung protective ventilation. Recommendations especially relevant to the COVID-19 long-haulers include assessment of critical care myopathies and neuropathies to determine suitable neuromuscular blocking agents and reversal, preoperative workup of insidious cardiac or pulmonary pathologies in previously healthy patients, and thorough medication review, particularly of anticoagulation regimens and chronic steroid use. In this article, we define the syndrome, synthesize the available scientific evidence, and make pragmatic suggestions regarding the perioperative clinical care of COVID-19 long-haulers.

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“…Following SARS-CoV-2 infection, patients may experience long-term health consequences, including, among others, persistent radiographic abnormalities (organizing pneumonia, fibrotic-like changes, bronchiectasis) [49][50][51][52][53] and post intubation or post tracheostomy complications, such as tracheal stenosis or granuloma formation [54]. Bronchoscopy may also play a role in the diagnosis and management of these long-term complications.…”

Section: Future Evidence and Perspectives: "The New Routine"mentioning

confidence: 99%

“…Among severe COVID-19 patients, endotracheal intubation and mechanical ventilation are often necessary. Tracheal stenosis, a well-known long-term complication of intubation [59,60], has also recently been described in COVID-19 intubated patients [54]. Bronchoscopy is a useful tool for the diagnosis and the management of this sequela.…”

Section: Future Evidence and Perspectives: "The New Routine"mentioning

confidence: 99%

The Role of Bronchoscopy in the Diagnosis and Management of Patients with SARS-Cov-2 Infection

et al. 2021

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Bronchoscopy has several major diagnostic and therapeutic indications in pulmonology. However, it is an aerosol-generating procedure that places healthcare providers at an increased risk of infection. Now more than ever, during the spread of the coronavirus disease 2019 (COVID-19) pandemic, the infectious risk during bronchoscopy is significantly raised, and for this reason its role in diagnostic management is debated. In this review, we summarized current evidence regarding the indications for bronchoscopy and the measures that should be applied to decrease risk exposure. Indeed, seeing the long-lasting period of the pandemic, resuming standard of care for all patients is required.

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Post-intubation tracheal stenosis in COVID-19 patients

Cited by 48 publications

References 7 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

Post-Acute COVID-19 Syndrome for Anesthesiologists: A Narrative Review and a Pragmatic Approach to Clinical Care

The Role of Bronchoscopy in the Diagnosis and Management of Patients with SARS-Cov-2 Infection

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