Intubated COVID-19 Patients More Likely to Develop Subglottic Stenosis

Acquired subglottic stenosis (SGS) is commonly caused by prolonged intubation and elevated cuff pressures. Severe COVID-19 patients requiring extended ventilation are at higher risk of laryngotracheal injury. However, SGS incidence in COVID-19 versus non-COVID-19 patients remains underexplored. To compare the incidence of SGS and frequency of subglottic dilation procedures following intubation in patients with or without a history of recent COVID-19 infection.

Utilizing the TriNetX database, queries were conducted for adult patients intubated between January 20, 2020 and December 31, 2023. Demographics, comorbidities, and COVID-19 infection histories were collected. Patients were divided into two cohorts based on their COVID-19 status < 2 weeks prior to hospitalization and propensity-score matched for demographics and comorbidities. Incidence of SGS and frequency of subglottic dilation/tracheostomy procedures occurring during the same hospitalization as the patient's intubation were compared.

About 105,443 COVID+ and 79,848 COVID- patients had histories of intubation. After matching, each cohort had 70,000 patients; 39% (N = 54,661) female, 58.5% (N = 81,852) male. Mean age at time of intubation was 57 years. COVID+ patients were more likely to develop SGS, odds ratio (OR) 1.3 (95% CI 1.1-1.5; p = 0.0004), and more likely to undergo tracheostomy, OR = 1.2 (95% CI = 1.1-1.2; p < 0.001). COVID+ patients with SGS were more likely to undergo subglottic dilation procedures, OR 1.3 (95% CI 1.0-1.7; p = 0.02). There was no significant difference in the number of dilation procedures or mortality rates between cohorts.

Intubated patients with COVID-19 were more likely to develop SGS than those without infection and were more likely to require invasive procedures to address complications of long-term intubation.