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. 2022 Aug;84(4):805-813.
doi: 10.1007/s12262-022-03498-x. Epub 2022 Jul 7.

Complex Post-intubation Tracheal Stenosis in Covid-19 Patients

Muhammet Ali Beyoglu  1 , Mehmet Furkan Sahin  1 , Sinan Turkkan  1 , Alkin Yazicioglu  1 , Erdal Yekeler  1
Affiliations

Complex Post-intubation Tracheal Stenosis in Covid-19 Patients

Muhammet Ali Beyoglu et al. Indian J Surg. 2022 Aug.

Abstract

Management of tracheal complications due to endotracheal intubation in patients with coronavirus disease-2019 (COVID-19) is an important concern. This study aimed to present the results of patients who had undergone tracheal resection and reconstruction due to COVID-19-related complex post-intubation tracheal stenosis (PITS). We evaluated 15 patients who underwent tracheal resection and reconstruction due to complex PITS between March 2020 and April 2021 in a single center. Seven patients (46.6%) who underwent endotracheal intubation due to the COVID-19 constituted the COVID-19 group, and the remaining 8 patients (53.4%) constituted the non-COVID-19 group. We analyzed the patients' presenting symptoms, time to onset of symptoms, radiological and bronchoscopic features of stenosis, bronchoscopic intervention history, length of the resected tracheal segment, postoperative complications, length of hospital stay, and duration of follow-up. Six of the patients (40%) were female, and 9 (60%) were male. Mean age was 43.3 ± 20.5. We found no statistically significant difference between the COVID-19 and non-COVID-19 PITS groups in terms of presenting symptoms, time to onset of symptoms, stenosis location, stenosis severity, length of the stenotic segment, number of bronchoscopic dilatation sessions, dilatation time intervals, length of the resected tracheal segment, postoperative complications, and length of postoperative hospital stay. Endotracheal intubation duration was longer in the COVID-19 group than non-COVID-19 group (mean ± SD: 21.0 ± 4.04, 12.0 ± 1.15 days, respectively). Tracheal resection and reconstruction can be performed safely and successfully in COVID-19 patients with complex PITS. Comprehensive preoperative examination, appropriate selection of surgery technique, and close postoperative follow-up have favorable results.

Keywords: COVID-19; Novel coronavirus; Post-intubation; SARS-CoV-2; Tracheal resection; Tracheal stenosis.

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Conflict of interest statement

Conflict of InterestThe authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Computed tomographic view of the tracheal stenosis. a 3-Dimensional reformation of the trachea. The narrowest tracheal segment was marked with a white arrow. b Axial plain computed tomography reveals the narrowest tracheal segment (marked with black arrow). The patient was relieved symptomatically with tracheal dilatation, and then, elective tracheal resection and reconstruction was performed
Fig. 2
Fig. 2
Images of post-intubation tracheal stenosis surgery. a The appearance of a collar incision where a vertical incision will be inserted towards the jugular notch when the head is in semi-extension (LP: laryngeal prominence, C: cricoid cartilage). b Tracheal puncture for precise determination of stenosis margins, accompanied by bronchoscopy. c Appearance of resected tracheal segment, d Final view of the tracheal anastomosis line (lateral support suture is marked with white arrow)
Fig. 3
Fig. 3
Group distribution plot of resected tracheal segment lengths. The resected tracheal segment lengths are shown as a box plot in millimeter according to the COVID-19 and non-COVID-19 groups
See this image and copyright information in PMC

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