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Case Reports
. 2020 Aug 14:21:e926731.
doi: 10.12659/AJCR.926731.

Tracheal Stenosis After Tracheostomy for Mechanical Ventilation in COVID-19 Pneumonia - A Report of 2 Cases from Northern Italy

Carmine Fernando Gervasio  1 , Gianluca Averono  1 , Luca Robiolio  1 , Massimo Bertoletti  2 , Umberto Colageo  3 , Luca De Col  3 , Fabio Bertone  1
Affiliations
Case Reports

Tracheal Stenosis After Tracheostomy for Mechanical Ventilation in COVID-19 Pneumonia - A Report of 2 Cases from Northern Italy

Carmine Fernando Gervasio et al. Am J Case Rep. .

Abstract

BACKGROUND The role of tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic is still to be determined, and the complication rate of the tracheostomy in COVID-19 patients is still unknown. Postintubation tracheal stenosis is a well-known risk of prolonged endotracheal intubation, but it is too early to define the existence of any difference among the COVID-19 cohort of patients and non-COVID-19 patients. This report is of 2 cases of COVID-19 pneumonia that required tracheostomy and prolonged endotracheal intubation, which were followed by delayed tracheal stenosis. CASE REPORT Case 1. A 54-year-old male was admitted to our hospital (Biella, Italy) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The patient underwent orotracheal intubation, progressively improving his breathing function, and was discharged after 20 days. Ten days later, the patient presented with severe respiratory distress. Computed tomography (CT) scan and bronchoscopy showed signs of tracheal stenosis. We administered intravenous steroids for 10 days. The patient showed increasing improvement in his breathing function and was discharged with no other signs of respiratory distress. Case 2. A 43-year-old male was admitted to our hospital for SARS-CoV-2 infection. The patient underwent orotracheal intubation, progressively improving his breathing function, and was discharged after 25 days. Eighteen days later, the patient came to our emergency room with severe respiratory distress. CT scan and bronchoscopy showed signs of tracheal stenosis. The patient had to undergo tracheal resection. CONCLUSIONS The 2 cases presented in this report have shown that even when patients recover from severe COVID-19 pneumonia requiring tracheostomy and mechanical ventilation, tracheal stenosis should be recognized as a potential complication and careful follow-up is required.

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Conflict of interest statement

Conflict of interest: None declared

Conflicts of interest

None.

Figures

Figure 1.
Figure 1.
Case 1. Lung computed-tomography (CT) image from a 54-year-old man with coronavirus disease 2019 pneumonia who required tracheostomy for mechanical ventilation. Ten days after hospital discharge, the patient returned with respiratory distress. The CT scan shows tracheal stenosis (arrow) with clear lung fields.
Figure 2.
Figure 2.
Case 1. Bronchoscopic image from a 54-year-old man with coronavirus disease 2019 pneumonia who required tracheostomy for mechanical ventilation. The bronchoscopy shows the tracheal stenosis that occurred 10 days after hospital discharge.
Figure 3.
Figure 3.
Case 2. Lung computed-tomography (CT) image from a 43-year-old man with coronavirus disease 2019 pneumonia who required tracheostomy for mechanical ventilation. Eighteen days after hospital discharge, the patient returned with respiratory distress. The CT scan shows tracheal stenosis (arrow) with clear lung fields.
Figure 4.
Figure 4.
Case 2. Bronchoscopic image from a 43-year-old man with coronavirus disease 2019 pneumonia who required tracheostomy for mechanical ventilation. The bronchoscopy shows the tracheal stenosis that occurred 18 days after hospital discharge.
See this image and copyright information in PMC

References

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