Serial histopathological tracheal changes from prolonged intubations

Din, Mohamed H. Badr El; Ahmed, Mohamed; Hinnis, Adel R.; Baky, Moustafa S. Abd El

doi:10.4103/1012-5574.133218

Cited by 3 publications

(5 citation statements)

References 21 publications

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“…Therefore, the relatively minor degree of tissue inflammation demonstrated in Groups 1 , 2 and 3 is most likely due to mechanical irritation and tracheal cuff pressure effects, and does not appear to be COVID‐19 disease‐specific. These histological appearances are largely consistent with those described in historical studies of mechanically ventilated COVID‐19 negative patients 6,7 …”

Section: Discussionsupporting

confidence: 85%

“…These histological appearances are largely consistent with those described in historical studies of mechanically ventilated COVID‐19 negative patients. 6 , 7 …”

Section: Discussionmentioning

confidence: 99%

“…These histological appearances are largely consistent with those described in historical studies of mechanically ventilated COVID-19 negative patients. 6,7 Minor ulceration was an infrequent finding. Only two TWs (from The study periods for first and second pandemic waves were selected to match respective peaks in AICU admissions and, therefore, ST.…”

Section: Discussionmentioning

confidence: 99%

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Histological findings of tracheal samples from COVID‐19 positive critically ill mechanically ventilated patients

Ward

Collier

Weir

et al. 2021

Clinical Otolaryngology

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Objectives This study examines the histological findings of tracheal tissue samples obtained from COVID‐19 positive mechanically ventilated patients, to assess the degree of tracheal inflammation/ulceration present. Design and participants Retrospective single‐centre observational cohort study. All patients admitted to Adult Intensive Care Unit (AICU) with COVID‐19 infection, requiring mechanical ventilation and surgical tracheostomy between 1 April and 1 May 2020, were included ( Group 1 ). Tracheal windows excised at tracheostomy underwent histological analysis. Comparison was made with: tracheal windows from COVID‐19 positive AICU ventilated patients admitted between 1 January and 1 March 2021 ( Group 2 ); tracheal windows from COVID‐19 negative AICU ventilated patients ( Group 3 ); and, tracheal autopsy samples from COVID‐19 positive patients that died without undergoing prolonged mechanical ventilation ( Group 4 ). Results G roup 1 demonstrated mild/moderate inflammation (tracheitis) in nearly all samples (15/16, 93.8%), with infrequent micro‐ulceration (2/16, 12.5%). G roup 2 demonstrated similar mild/moderate inflammation in all samples (17/17, 100%), with no ulceration. Histological findings of Groups 1 and 2 COVID‐19 positive patients were similar to Group 3 COVID‐19 negative patients, which demonstrated mild/moderate inflammation (5/5, 100%), with uncommon superficial erosion (1/5, 20%). Group 4 demonstrated mild chronic inflammation or no significant inflammation, with uncommon micro‐ulceration (1/4, 25%). Conclusions Severe tracheal inflammation was not demonstrated in mechanically ventilated COVID‐19 positive patients at the level of the second/third tracheal rings, at the stage of disease patients underwent tracheostomy. Histological findings were similar between mechanically ventilated COVID‐19 positive and negative patients. Tracheal ulceration may be a feature of early or severe COVID‐19 disease.

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Section: Discussionsupporting

confidence: 85%

“…These histological appearances are largely consistent with those described in historical studies of mechanically ventilated COVID‐19 negative patients. 6 , 7 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Histological findings of tracheal samples from COVID‐19 positive critically ill mechanically ventilated patients

Ward

Collier

Weir

et al. 2021

Clinical Otolaryngology

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“…Increased upper airway mucosal thickness is a known ETT intubation-related morbidity seen on histological specimens in animals 21,36,38 and humans. 39,40 These histological findings are part of the defining pathogenetic basis for ETT-related upper airway morbidity observed in extubated patients, as discussed previously. Moreover, we investigated fibrosis in the tracheal mucosa as an indicator of airway damage.…”

Section: Discussionmentioning

confidence: 64%

“…Findings were remarkable as the mean mucosal thickness in the loaded-ETT group was significantly less compared to that in the blank-ETT group and almost equal to the mean mucosal thickness in the control group. Increased upper airway mucosal thickness is a known ETT intubation-related morbidity seen on histological specimens in animals ,, and humans. , These histological findings are part of the defining pathogenetic basis for ETT-related upper airway morbidity observed in extubated patients, as discussed previously. Moreover, we investigated fibrosis in the tracheal mucosa as an indicator of airway damage.…”

Section: Discussionmentioning

confidence: 66%

Local Delivery of Mometasone Furoate from an Eluting Endotracheal Tube Reduces Airway Morbidity Following Long-Term Animal Intubation

Jahshan

Ammar

Ertracht

et al. 2021

ACS Appl. Bio Mater.

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Background: upper airway complications are common sequelae of endotracheal tube (ETT) intubation, and systemic corticosteroids are considered a mainstay treatment for this problem. Drug-eluting ETT may present an attractive option for topical steroid delivery while avoiding systemic side effects and improving the therapeutic outcome. The objective of the present study is to evaluate the reduction of tube-related tracheal morbidity via a self-designed steroid-eluting ETT with controlled sustained release properties in an animal model. Methods: steroideluting ETTs were coated by poly(lactic-co-glycolic acid) -electrospun nanofibers loaded with mometasone furoate (MF) as a model drug. Animals were randomly assigned into three equal groups: non-intubated, blank-ETT, and loaded-ETT. The intubation interval was 1 week. Specimens were analyzed by histology, specific fibrosis staining, and scanning electron microscopy (SEM). Results: the blank-ETT group exhibited a significant increase in tracheal mucosal thickness compared to the loaded-ETT and control groups. Average tracheal mucosal thickness was 112 ± 34, 242 ± 49, and 113 ± 43 μm in the control, blank-ETT, and loaded-ETT groups, respectively. The blank-ETT group exhibited a significant increase in tracheal fibrosis compared to the loaded-ETT and control groups. Relative fibrosis values were 0.07 ± 0.05, 0.154 ± 0.1, and 0.0984 ± 0.084% for the control, blank-ETT, and loaded-ETT groups, respectively. While SEM imaging showed normal surface structures in the control group, intubated blank-ETT rats showed severe surface structural damage, whereas only mild damage was observed in the loaded-ETT group. Conclusions: local sustained release of MF via a self-designed drug-eluting ETT is a potential therapeutic approach which may significantly reduce tuberelated upper airway morbidity.

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Role of Primary Aetiology of Intubation in Acquired Laryngotracheal Stenosis: An Institutional Audit and Review of Literature

Saravanam

Manimaran

2020

Indian J Otolaryngol Head Neck Surg

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Serial histopathological tracheal changes from prolonged intubations

Cited by 3 publications

References 21 publications

Histological findings of tracheal samples from COVID‐19 positive critically ill mechanically ventilated patients

Histological findings of tracheal samples from COVID‐19 positive critically ill mechanically ventilated patients

Local Delivery of Mometasone Furoate from an Eluting Endotracheal Tube Reduces Airway Morbidity Following Long-Term Animal Intubation

Role of Primary Aetiology of Intubation in Acquired Laryngotracheal Stenosis: An Institutional Audit and Review of Literature

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