Subglottic and tracheal stenosis associated with coronavirus disease 2019

Area of Science:

• Otolaryngology
• Critical Care Medicine
• Pulmonology

Background:

• Prolonged intubation in Coronavirus disease 2019 (COVID-19) patients increases risks for subglottic and tracheal stenosis.
• Co-morbidities like obesity and reflux exacerbate stenosis risk in this patient group.
• Late tracheostomy and large endotracheal tubes contribute to airway injury.

Observation:

• Three COVID-19 patients developed complex, multi-level laryngotracheal stenoses after prolonged intubation (mean 28 days) and delayed tracheostomy.
• These patients required multiple endoscopic tracheoplasty procedures and tracheal resections.
• Interventions were spaced over a mean of 33.9 days, indicating complex reconstructions.

Findings:

• COVID-19 patients with laryngotracheal stenosis showed a poorer response to standard treatments like steroid therapy, laser ablation, and balloon dilatation compared to other adult stenosis cases.
• The severity and complexity of stenosis in this cohort necessitate aggressive surgical management.

Implications:

• Otolaryngology teams must maintain high vigilance for laryngotracheal stenosis in intubated COVID-19 patients.
• Adherence to international guidelines on timely tracheostomy is recommended, irrespective of COVID-19 diagnosis.
• Early recognition and management are vital to prevent severe airway compromise in post-COVID-19 critical care survivors.