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Subglottic and tracheal stenosis associated with coronavirus disease 2019

Part of: JLO Coronavirus Collection

Published online by Cambridge University Press:  11 May 2021

D W Scholfield ,
E Warner ,
J Ahmed  and
K Ghufoor
D W Scholfield*
Affiliation:
ENT – Head and Neck Department, Royal London Hospital, Barts NHS Healthcare Trust, London, UK
E Warner
Affiliation:
ENT – Head and Neck Department, Royal London Hospital, Barts NHS Healthcare Trust, London, UK
J Ahmed
Affiliation:
ENT – Head and Neck Department, Royal London Hospital, Barts NHS Healthcare Trust, London, UK
K Ghufoor
Affiliation:
ENT – Head and Neck Department, Royal London Hospital, Barts NHS Healthcare Trust, London, UK
*
Author for correspondence: Mr Daniel Scholfield, ENT – Head and Neck Department, Royal London Hospital, Barts NHS Healthcare Trust, London, UK E-mail: danwscholfield@doctors.org.uk
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Abstract

Background

Coronavirus disease 2019 critical care patients endure prolonged periods of intubation. Late tracheostomy insertion, large endotracheal tubes and high cuff pressures increase their risk of subglottic and tracheal stenosis. This patient cohort also often appears to have co-morbidities associated with laryngotracheal stenosis, including high body mass index and laryngopharyngeal reflux.

Methods

This paper presents three coronavirus disease 2019 patients who were intubated for a mean of 28 days before tracheostomy, leading to complex multi-level stenoses.

Results

All patients underwent multiple endoscopic tracheoplasty procedures and two required tracheal resections. There was a mean of 33.9 days between interventions. Coronavirus disease 2019 patients do not appear to respond as well to steroid, laser and balloon dilatation as other adult stenosis patients.

Conclusion

Intubated coronavirus disease 2019 patients have an increased risk of laryngotracheal stenosis, as a result of multiple factors. Otolaryngology teams should be vigilant in investigating for this complication. International guidelines on time to tracheostomy should be followed, despite a diagnosis of coronavirus disease 2019.

Keywords

COVID-19TracheostomyTracheaLarynxIntubation
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 7 , July 2021 , pp. 656 - 658
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Mr D Scholfield takes responsibility for the integrity of the content of the paper

References

Ziegler, CGK, Allon, SJ, Nyquist, SK, Mbano, IM, Miao, VN, Tzouanas, CN et al. SARS-CoV-2 receptor ACE2 is an interferon-stimulated gene in human airway epithelial cells and is detected in specific cell subsets across tissues. Cell 2020;181:1016–35CrossRefGoogle ScholarPubMed
Li, M, Yiu, Y, Merrill, T, Yildiz, V, deSilva, B, Matrka, L. Risk factors for posttracheostomy tracheal stenosis. Otolaryngol Head Neck Surg 2018;159:698–704CrossRefGoogle ScholarPubMed
Naunheim, MR, Zhou, AS, Puka, E, Franco, RA Jr, Carroll, TL, Teng, SE et al. Laryngeal complications of COVID-19. Laryngoscope Investig Otolaryngol 2020;5:1117–24CrossRefGoogle ScholarPubMed
Nouraei, SA, Kapoor, KV, Nouraei, SM, Ghufoor, K, Howard, DJ, Sandhu, GS. Results of endoscopic tracheoplasty for treating tracheostomy-related airway stenosis. Clin Otolaryngol 2007;32:471–5CrossRefGoogle ScholarPubMed
Feinstein, AJ, Goel, A, Raghavan, G, Long, J, Chhetri, DK, Berke, GS et al. Endoscopic management of subglottic stenosis. JAMA Otolaryngol Head Neck Surg 2017;143:500–5CrossRefGoogle ScholarPubMed
Vargas, M, Sutherasan, Y, Antonelli, M, Brunetti, I, Corcione, A, Laffey, JG et al. Tracheostomy procedures in the intensive care unit: an international survey. Crit Care 2015;19:291CrossRefGoogle Scholar
Nicolli, EA, Carey, RM, Farquhar, D, Haft, S, Alfonso, KP, Mirza, N. Risk factors for adult acquired subglottic stenosis. J Laryngol Otol 2017;131:264–7CrossRefGoogle ScholarPubMed