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European Archives of Oto-Rhino-Laryngology
Published in: European Archives of Oto-Rhino-Laryngology 1/2021

01-01-2021 | COVID-19 | Review Article

Long-term intubation and high rate of tracheostomy in COVID-19 patients might determine an unprecedented increase of airway stenoses: a call to action from the European Laryngological Society

Authors: Cesare Piazza, Marta Filauro, Frederik G. Dikkers, S. A. Reza Nouraei, Kishore Sandu, Christian Sittel, Milan R. Amin, Guillermo Campos, Hans E. Eckel, Giorgio Peretti

Published in: European Archives of Oto-Rhino-Laryngology | Issue 1/2021

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Abstract

Introduction

The novel Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, may need intensive care unit (ICU) admission in up to 12% of all positive cases for massive interstitial pneumonia, with possible long-term endotracheal intubation for mechanical ventilation and subsequent tracheostomy. The most common airway-related complications of such ICU maneuvers are laryngotracheal granulomas, webs, stenosis, malacia and, less commonly, tracheal necrosis with tracheo-esophageal or tracheo-arterial fistulae.

Materials and methods

This paper gathers the opinions of experts of the Laryngotracheal Stenosis Committee of the European Laryngological Society, with the aim of alerting the medical community about the possible rise in number of COVID-19-related laryngotracheal stenosis (LTS), and the aspiration of paving the way to a more rationale concentration of these cases within referral specialist airway centers.

Results

A range of prevention strategies, diagnostic work-up, and therapeutic approaches are reported and framed within the COVID-19 pandemic context.

Conclusions

One of the most important roles of otolaryngologists when encountering airway-related signs and symptoms in patients with previous ICU hospitalization for COVID-19 is to maintain a high level of suspicion for LTS development, and share it with colleagues and other health care professionals. Such a condition requires specific expertise and should be comprehensively managed in tertiary referral centers.
Literature
1.
Guan WJ, Ni ZY, Hu Y et al (2020) Clinical characteristics of Coronavirus disease 2019 in China. N Engl J Med 382:1708–1720CrossRef
2.
3.
Huang C, Wang Y, Li X et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395:497–506CrossRef
4.
Wang D, Hu B, Hu C et al (2020) Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected pneumonia in Wuhan. JAMA 323:1061–1069CrossRef
5.
6.
Phua J, Weng L, Ling L et al (2020) Intensive care management of Coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med 8:506–517CrossRef
7.
Grasselli G, Zangrillo A, Zanella A et al (2020) Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA 323:1574–1581CrossRef
8.
9.
Freeman BD, Morris PE (2012) Tracheostomy practice in adults with acute respiratory failure. Crit Care Med 40:2890–2896CrossRef
10.
Siempos II, Ntaidou TK, Filippidis FT, Choi AMK (2015) Effect of early versus late or no tracheostomy on mortality and pneumonia of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis. Lancet Respir Med 3:150–158CrossRef
11.
Cheung NH, Napolitano LM (2014) Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care 59:895–899CrossRef
12.
Huang H, Li Y, Ariani F, Chen X, Lin J (2014) Timing of tracheostomy in critically ill patients: a meta-analysis. PLoS ONE 9:e92981CrossRef
13.
Lin WC, Chen CW, Wang JD, Tsai LM (2015) Is tracheostomy a better choice than translaryngeal intubation for critically ill patients requiring mechanical ventilation for more than 14 days? A comparison of short-term outcomes. BMC Anesthesiol 15:181CrossRef
14.
15.
To KK, Tsang OT, Leung WS et al (2020) Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect Dis 20:565–574CrossRef
16.
Fiz I, Monnier P, Koelmel JC et al (2019) Multicentric study applying the European Laryngological Society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis. Laryngoscope. https://​doi.​org/​10.​1002/​lary.​28274(Published online ahead of print, 2019 Sep 11)CrossRefPubMed
17.
Nikolovski N, Kopacheva-Barsova G, Pejkovska A (2019) Laryngotracheal stenosis: a retrospective analysis of their aetiology, diagnose and treatment. Open Access Maced J Med Sci 7:1649–1656CrossRef
18.
Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A (2020) Consensus guidelines for managing the airway in patients with COVID-19. Anaesthesia 75:785–799CrossRef
19.
20.
Barjaktarevic I, Esquinas AM, West FM, Albores J, Berlin D (2017) Noninvasive ventilation in difficult endotracheal intubation: systematic and review analysis. Anaesthesiol Intensive Ther 49:294–302PubMed
21.
Rao KVN, Dhatchinamoorthi D, Nandhakumar A, Selvarajan N, Akula HR, Thiruvenkatarajan V (2018) Validity of thyromental height test as a predictor of difficult laryngoscopy: a prospective evaluation comparing modified Mallampati score, interincisor gap, thyromental distance, neck circumference, and neck extension. Indian J Anaesth 62:603–608CrossRef
22.
Schnittker R, Marshall SD, Berecki-Gisolf J (2020) Patient and surgery factors associated with the incidence of failed and difficult intubation. Anaesthesia 75:756–766CrossRef
23.
Nasa VK, Kamath SS (2014) Risk factors assessment of the difficult intubation using Intubation Difficulty Scale (IDS). J Clin Diagn Res 8:GC01–GC03
24.
Myers LA, Gallet CG, Kolb LJ, Lohse CM, Russi CS (2016) Determinants of success and failure in prehospital endotracheal intubation. West J Emerg Med 17:640–647CrossRef
25.
Shinn JR, Kimura KS, Campbell BR et al (2019) Incidence and outcomes of acute laryngeal injury after prolonged mechanical ventilation. Crit Care Med 47:1699–1706CrossRef
26.
Sengupta P, Sessler DI, Maglinger P et al (2004) Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure. BMC Anesthesiol 4:4–9CrossRef
27.
Seegobin RD, Van Hasselt GL (1984) Endotracheal cuff pressure and tracheal mucosal blood flow: endoscopic study of effects of four large volume cuffs. Br Med J 288:965–968CrossRef
28.
Liu J, Zhang X, Gong W et al (2010) Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study. Anesth Analg 111:1133–1137CrossRef
29.
30.
de Kleijn BJ, Wedman J, Zijlstra JG, Dikkers FG, van der Laan BFAM (2019) Short- and long-term complications of surgical and percutaneous dilatation tracheotomies: a large single-center retrospective cohort study. Eur Arch Otorhinolaryngol 276:1823–1828CrossRef
31.
Nouraei SA, Winterborn C, Nouraei SM et al (2007) Quantifying the physiology of laryngotracheal stenosis: changes in pulmonary dynamics in response to graded extrathoracic resistive loading. Laryngoscope 117:581–588CrossRef
32.
Nouraei SA, Nouraei SM, Patel A et al (2013) Diagnosis of laryngotracheal stenosis from routine pulmonary physiology using the Expiratory Disproportion Index. Laryngoscope 123:3099–3104CrossRef
33.
Monnier P, Dikkers FG, Eckel H et al (2015) Preoperative assessment and classification of benign laryngotracheal stenosis: a consensus paper of the European Laryngological Society. Eur Arch Otorhinolaryngol 272:2885–2896CrossRef
34.
Myer CM, O’Connor DM, Cotton RT (1994) Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 103:319–323CrossRef
35.
Kocdor P, Siegel ER, Suen JY, Richter G, Tulunay-Ugur OE (2016) Comorbidities and factors associated with endoscopic surgical outcomes in adult laryngotracheal stenosis. Eur Arch Otorhinolaryngol 273:419–424CrossRef
36.
Bogdasarian RS, Olson NR (1980) Posterior glottic laryngeal stenosis. Otolaryngol Head Neck Surg 88:765–772CrossRef
37.
Lewis S, Earley M, Rosenfeld R, Silverman J (2017) Systematic review for surgical treatment of adult and adolescent laryngotracheal stenosis. Laryngoscope 127:191–198CrossRef
Metadata
Title
Long-term intubation and high rate of tracheostomy in COVID-19 patients might determine an unprecedented increase of airway stenoses: a call to action from the European Laryngological Society
Authors
Cesare Piazza
Marta Filauro
Frederik G. Dikkers
S. A. Reza Nouraei
Kishore Sandu
Christian Sittel
Milan R. Amin
Guillermo Campos
Hans E. Eckel
Giorgio Peretti
Publication date
01-01-2021
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology / Issue 1/2021
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-020-06112-6

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