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

During the current pandemic, we witnessed a rise of post-intubation tracheal stenosis (PITS) in patients intubated due to COVID-19. We prospectively analyzed data from patients referred to our institution during the last 18 months for severe symptomatic post-intubation upper airway complications. In...

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Autores principales: Stratakos, Grigoris, Anagnostopoulos, Nektarios, Alsaggaf, Rajaa, Koukaki, Evangelia, Bakiri, Katerina, Emmanouil, Philip, Zisis, Charalampos, Vachlas, Konstantinos, Vourlakou, Christina, Koutsoukou, Antonia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8948992/
https://www.ncbi.nlm.nih.gov/pubmed/35330044
http://dx.doi.org/10.3390/jcm11061719
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author Stratakos, Grigoris
Anagnostopoulos, Nektarios
Alsaggaf, Rajaa
Koukaki, Evangelia
Bakiri, Katerina
Emmanouil, Philip
Zisis, Charalampos
Vachlas, Konstantinos
Vourlakou, Christina
Koutsoukou, Antonia
author_facet Stratakos, Grigoris
Anagnostopoulos, Nektarios
Alsaggaf, Rajaa
Koukaki, Evangelia
Bakiri, Katerina
Emmanouil, Philip
Zisis, Charalampos
Vachlas, Konstantinos
Vourlakou, Christina
Koutsoukou, Antonia
author_sort Stratakos, Grigoris
collection PubMed
description During the current pandemic, we witnessed a rise of post-intubation tracheal stenosis (PITS) in patients intubated due to COVID-19. We prospectively analyzed data from patients referred to our institution during the last 18 months for severe symptomatic post-intubation upper airway complications. Interdisciplinary bronchoscopic and/or surgical management was offered. Twenty-three patients with PITS and/or tracheoesophageal fistulae were included. They had undergone 31.85 (±22.7) days of ICU hospitalization and 17.35 (±7.4) days of intubation. Tracheal stenoses were mostly complex, located in the subglottic or mid-tracheal area. A total of 83% of patients had fracture and distortion of the tracheal wall. Fifteen patients were initially treated with rigid bronchoscopic modalities and/or stent placement and eight patients with tracheal resection-anastomosis. Post-treatment relapse in two of the bronchoscopically treated patients required surgery, while two of the surgically treated patients required rigid bronchoscopy and stent placement. Transient, non-life-threatening post-treatment complications developed in 60% of patients and were all managed successfully. The histopathology of the resected tracheal specimens didn’t reveal specific alterations in comparison to pre-COVID-era PITS cases. Prolonged intubation, pronation maneuvers, oversized tubes or cuffs, and patient- or disease-specific factors may be pathogenically implicated. An increase of post-COVID PITS is anticipated. Careful prevention, early detection and effective management of these iatrogenic complications are warranted.
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spelling pubmed-89489922022-03-26 COVID-19 Patients Presenting with Post-Intubation Upper Airway Complications: A Parallel Epidemic? Stratakos, Grigoris Anagnostopoulos, Nektarios Alsaggaf, Rajaa Koukaki, Evangelia Bakiri, Katerina Emmanouil, Philip Zisis, Charalampos Vachlas, Konstantinos Vourlakou, Christina Koutsoukou, Antonia J Clin Med Article During the current pandemic, we witnessed a rise of post-intubation tracheal stenosis (PITS) in patients intubated due to COVID-19. We prospectively analyzed data from patients referred to our institution during the last 18 months for severe symptomatic post-intubation upper airway complications. Interdisciplinary bronchoscopic and/or surgical management was offered. Twenty-three patients with PITS and/or tracheoesophageal fistulae were included. They had undergone 31.85 (±22.7) days of ICU hospitalization and 17.35 (±7.4) days of intubation. Tracheal stenoses were mostly complex, located in the subglottic or mid-tracheal area. A total of 83% of patients had fracture and distortion of the tracheal wall. Fifteen patients were initially treated with rigid bronchoscopic modalities and/or stent placement and eight patients with tracheal resection-anastomosis. Post-treatment relapse in two of the bronchoscopically treated patients required surgery, while two of the surgically treated patients required rigid bronchoscopy and stent placement. Transient, non-life-threatening post-treatment complications developed in 60% of patients and were all managed successfully. The histopathology of the resected tracheal specimens didn’t reveal specific alterations in comparison to pre-COVID-era PITS cases. Prolonged intubation, pronation maneuvers, oversized tubes or cuffs, and patient- or disease-specific factors may be pathogenically implicated. An increase of post-COVID PITS is anticipated. Careful prevention, early detection and effective management of these iatrogenic complications are warranted. MDPI 2022-03-20 /pmc/articles/PMC8948992/ /pubmed/35330044 http://dx.doi.org/10.3390/jcm11061719 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Stratakos, Grigoris
Anagnostopoulos, Nektarios
Alsaggaf, Rajaa
Koukaki, Evangelia
Bakiri, Katerina
Emmanouil, Philip
Zisis, Charalampos
Vachlas, Konstantinos
Vourlakou, Christina
Koutsoukou, Antonia
COVID-19 Patients Presenting with Post-Intubation Upper Airway Complications: A Parallel Epidemic?
title COVID-19 Patients Presenting with Post-Intubation Upper Airway Complications: A Parallel Epidemic?
title_full COVID-19 Patients Presenting with Post-Intubation Upper Airway Complications: A Parallel Epidemic?
title_fullStr COVID-19 Patients Presenting with Post-Intubation Upper Airway Complications: A Parallel Epidemic?
title_full_unstemmed COVID-19 Patients Presenting with Post-Intubation Upper Airway Complications: A Parallel Epidemic?
title_short COVID-19 Patients Presenting with Post-Intubation Upper Airway Complications: A Parallel Epidemic?
title_sort covid-19 patients presenting with post-intubation upper airway complications: a parallel epidemic?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8948992/
https://www.ncbi.nlm.nih.gov/pubmed/35330044
http://dx.doi.org/10.3390/jcm11061719
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