Not only acute respiratory failure: COVID-19 and the post-intubation/tracheostomy upper airways lesions†
BackgroundAn increasing number of patients have been subjected to prolonged invasive mechanical ventilation due to COVID-19 infection, leading to a significant number of post-intubation/tracheostomy (PI/T) upper airways lesions. The purpose of this study is to report our early experience in endoscop...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1150254/full |
| _version_ | 1827975732422246400 |
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| author | Debora Brascia Angela De Palma Mirko Girolamo Cantatore Ondina Pizzuto Francesca Signore Doroty Sampietro Mariangela Valentini Marcella Genualdo Giuseppe Marulli |
| author_facet | Debora Brascia Angela De Palma Mirko Girolamo Cantatore Ondina Pizzuto Francesca Signore Doroty Sampietro Mariangela Valentini Marcella Genualdo Giuseppe Marulli |
| author_sort | Debora Brascia |
| collection | DOAJ |
| description | BackgroundAn increasing number of patients have been subjected to prolonged invasive mechanical ventilation due to COVID-19 infection, leading to a significant number of post-intubation/tracheostomy (PI/T) upper airways lesions. The purpose of this study is to report our early experience in endoscopic and/or surgical management of PI/T upper airways injuries of patients surviving COVID-19 critical illness.Materials and MethodsWe prospectively collected data from patients referred to our Thoracic Surgery Unit from March 2020 to February 2022. All patients with suspected or documented PI/T tracheal injuries were evaluated with neck and chest computed tomography and bronchoscopy.ResultsThirteen patients (8 males, 5 females) were included; of these, 10 (76.9%) patients presented with tracheal/laryngotracheal stenosis, 2 (15.4%) with tracheoesophageal fistula (TEF) and 1 (7.7%) with concomitant TEF and stenosis. Age ranged from 37 to 76 years. Three patients with TEF underwent surgical repair by double layer suture of oesophageal defect associated with tracheal resection/anastomosis (1 case) or direct membranous tracheal wall suture (2 cases) and protective tracheostomy with T-tube insertion. One patient underwent redo-surgery after primary failure of oesophageal repair. Among 10 patients with stenosis, two (20.0%) underwent primary laryngotracheal resection/anastomosis, two (20.0%) had undergone multiple endoscopic interventions before referral to our Centre and, at arrival, one underwent emergency tracheostomy and T-tube positioning and one a removal of a previously positioned endotracheal nitinol stent for stenosis/granulation followed by initial laser dilatation and, finally, tracheal resection/anastomosis. Six (60.0%) patients were initially treated with rigid bronchoscopy procedures (laser and/or dilatation). Post-treatment relapse was experienced in 5 (50.0%) cases, requiring repeated rigid bronchoscopy procedures in 1 (10.0%) for definitive resolution of the stenosis and surgery (tracheal resection/anastomosis) in 4 (40.0%).ConclusionsEndoscopic and surgical treatment is curative in the majority of patients and should always be considered in PI/T upper airways lesions after COVID-19 illness. |
| first_indexed | 2024-04-09T20:16:04Z |
| format | Article |
| id | doaj.art-14053418011d45c596fa75b9b321580c |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-09T20:16:04Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-14053418011d45c596fa75b9b321580c2023-03-31T08:29:09ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2023-03-011010.3389/fsurg.2023.11502541150254Not only acute respiratory failure: COVID-19 and the post-intubation/tracheostomy upper airways lesions†Debora BrasciaAngela De PalmaMirko Girolamo CantatoreOndina PizzutoFrancesca SignoreDoroty SampietroMariangela ValentiniMarcella GenualdoGiuseppe MarulliBackgroundAn increasing number of patients have been subjected to prolonged invasive mechanical ventilation due to COVID-19 infection, leading to a significant number of post-intubation/tracheostomy (PI/T) upper airways lesions. The purpose of this study is to report our early experience in endoscopic and/or surgical management of PI/T upper airways injuries of patients surviving COVID-19 critical illness.Materials and MethodsWe prospectively collected data from patients referred to our Thoracic Surgery Unit from March 2020 to February 2022. All patients with suspected or documented PI/T tracheal injuries were evaluated with neck and chest computed tomography and bronchoscopy.ResultsThirteen patients (8 males, 5 females) were included; of these, 10 (76.9%) patients presented with tracheal/laryngotracheal stenosis, 2 (15.4%) with tracheoesophageal fistula (TEF) and 1 (7.7%) with concomitant TEF and stenosis. Age ranged from 37 to 76 years. Three patients with TEF underwent surgical repair by double layer suture of oesophageal defect associated with tracheal resection/anastomosis (1 case) or direct membranous tracheal wall suture (2 cases) and protective tracheostomy with T-tube insertion. One patient underwent redo-surgery after primary failure of oesophageal repair. Among 10 patients with stenosis, two (20.0%) underwent primary laryngotracheal resection/anastomosis, two (20.0%) had undergone multiple endoscopic interventions before referral to our Centre and, at arrival, one underwent emergency tracheostomy and T-tube positioning and one a removal of a previously positioned endotracheal nitinol stent for stenosis/granulation followed by initial laser dilatation and, finally, tracheal resection/anastomosis. Six (60.0%) patients were initially treated with rigid bronchoscopy procedures (laser and/or dilatation). Post-treatment relapse was experienced in 5 (50.0%) cases, requiring repeated rigid bronchoscopy procedures in 1 (10.0%) for definitive resolution of the stenosis and surgery (tracheal resection/anastomosis) in 4 (40.0%).ConclusionsEndoscopic and surgical treatment is curative in the majority of patients and should always be considered in PI/T upper airways lesions after COVID-19 illness.https://www.frontiersin.org/articles/10.3389/fsurg.2023.1150254/fullCOVID-19tracheal stenosistracheoesophageal fistulatracheal surgeryendoscopy |
| spellingShingle | Debora Brascia Angela De Palma Mirko Girolamo Cantatore Ondina Pizzuto Francesca Signore Doroty Sampietro Mariangela Valentini Marcella Genualdo Giuseppe Marulli Not only acute respiratory failure: COVID-19 and the post-intubation/tracheostomy upper airways lesions† Frontiers in Surgery COVID-19 tracheal stenosis tracheoesophageal fistula tracheal surgery endoscopy |
| title | Not only acute respiratory failure: COVID-19 and the post-intubation/tracheostomy upper airways lesions† |
| title_full | Not only acute respiratory failure: COVID-19 and the post-intubation/tracheostomy upper airways lesions† |
| title_fullStr | Not only acute respiratory failure: COVID-19 and the post-intubation/tracheostomy upper airways lesions† |
| title_full_unstemmed | Not only acute respiratory failure: COVID-19 and the post-intubation/tracheostomy upper airways lesions† |
| title_short | Not only acute respiratory failure: COVID-19 and the post-intubation/tracheostomy upper airways lesions† |
| title_sort | not only acute respiratory failure covid 19 and the post intubation tracheostomy upper airways lesions† |
| topic | COVID-19 tracheal stenosis tracheoesophageal fistula tracheal surgery endoscopy |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1150254/full |
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