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Αλέξανδρος Γ. Σφακιανάκης

Tuesday, September 14, 2021

Incidence of laryngotracheal lesions after orotracheal intubation in coronavirus disease patients

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Abstract

Objective

To evaluate the incidence of lesions and severe sequelae and the risk factors for the development of laryngotracheal lesions after orotracheal intubation (OTI) in coronavirus disease (COVID-19) patients.

Methods

In this prospective cohort study we evaluated patients diagnosed with COVID-19 who were consecutively admitted to a tertiary hospital and required OTI from March 1 to October 31, 2020. Patients discharged were called for outpatient follow-up and endoscopic examination.

Results

A total of 1,357 patients diagnosed with COVID-19, as confirmed by nasal swab RT-PCR, were admitted. OTI for mechanical ventilation was required in 421 patients (31%). Of the intubated patients, 172 (40.9%) were discharged and 249 (59.1%) died. Outpatient evaluation by videoendoscopy was performed in 95 patients (55.2%) approximately 100 days after extubation. Laryngotracheal lesions were observed in 38 patients (40%), with 17.9% diagnosed with laryngotracheal stenosis or unilateral immobility while 6.3% had severe stenosis (grades 3 and 4). The factors presenting statistical significance for the development of laryngotracheal lesions were the endotracheal tube size, prone position over the OTI period, and the increased leukocyte count, D-dimer, prothrombin time (PT), and international normalized ratio (INR) on the day OTI was performed.

Conclusions

The incidence of laryngotracheal lesion in COVID-19 patients is 40%, with 6.3% of them presenting with severe stenosis. There was a greater risk for the development of laryngotracheal lesions in patients using a larger endotracheal tube, kept in a prone position, presenting a greater inflammatory reaction (increased leukocyte count), or developing coagulation disorders (increased D-dimer, PT, and INR).

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