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Airway management is essential in emergency and surgical medicine, ensuring ventilation and oxygenation in patients who cannot maintain their own airway. Clinicians use a range of techniques and devices to secure the airway, depending on the patient’s condition and the clinical context. Key methods include endotracheal intubation, rapid sequence intubation (RSI), supraglottic airway devices, and advanced visualization aids. In cases where these approaches fail, surgical airway...
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Intubated COVID-19 Patients More Likely to Develop Subglottic Stenosis.

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  • 1School of Osteopathic Medicine University of the Incarnate Word San Antonio Texas USA.

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|April 22, 2026
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Summary

Patients intubated with COVID-19 had a higher incidence of acquired subglottic stenosis (SGS) and required more procedures for airway complications. This study highlights the increased risk of laryngotracheal injury in COVID-19 patients following intubation.

Keywords:
COVID‐19intubationlaryngostenosisretrospective studiestracheostomy

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Area of Science:

  • Otolaryngology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Acquired subglottic stenosis (SGS) is a known complication of prolonged endotracheal intubation, often linked to high cuff pressures.
  • Severe COVID-19 necessitates extended mechanical ventilation, increasing the risk of laryngotracheal injury.
  • The comparative incidence of SGS in COVID-19 versus non-COVID-19 patients post-intubation is not well-established.

Purpose of the Study:

  • To compare the incidence of acquired subglottic stenosis (SGS) in intubated patients with and without recent COVID-19 infection.
  • To evaluate the frequency of subglottic dilation and tracheostomy procedures in these cohorts.
  • To assess the association between COVID-19 status and the need for interventions for SGS.

Main Methods:

  • A retrospective analysis of the TriNetX database was performed for adult patients intubated between January 2020 and December 2023.
  • Patients were stratified into COVID-19 positive (COVID+) and COVID-19 negative (COVID-) cohorts based on infection status within two weeks of hospitalization.
  • Propensity-score matching was used to balance demographic and comorbidity profiles between the two cohorts.

Main Results:

  • After propensity-score matching, 70,000 patients were in each cohort (COVID+ and COVID-).
  • COVID+ patients demonstrated a significantly higher incidence of SGS (OR 1.3, p=0.0004) and underwent tracheostomy more frequently (OR 1.2, p<0.001).
  • COVID+ patients diagnosed with SGS were more likely to require subglottic dilation procedures (OR 1.3, p=0.02).

Conclusions:

  • Intubated patients with COVID-19 face a greater risk of developing acquired subglottic stenosis compared to non-COVID-19 patients.
  • COVID-19 infection is associated with an increased likelihood of requiring invasive procedures for airway complications resulting from intubation.
  • These findings underscore the importance of vigilant airway monitoring in COVID-19 patients requiring mechanical ventilation.