Intubated COVID-19 Patients More Likely to Develop Subglottic Stenosis

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.