Laryngotracheal Pathologies and Symptoms Associated to Airway Management of Critically Ill COVID-19 Patients at One-Year Follow Up: An Observational Study

Abstract

Background: The European laryngological society predicted an increased incidence of laryngotracheal complications as a result of the COVID-19 pandemic. During the first pandemic wave in the Stockholm region, 31% of critically ill COVID-19 patients were tracheotomized by an open surgical (OST) or a percutaneous tracheotomy (PCT). The aim of this study was to investigate the incidence of visible laryngotracheal pathologies in tracheotomized and long-term intubated COVID-19 survivors ≥ 12 months after initial intubation, to examine whether these pathologies were symptomatic and to assess possible associated factors.

Methods: Study participants underwent laryngotracheoscopy under local anaesthesia, and tracheostomy skin and soft tissue scars were photo documented. Patient-reported outcome measures - the Voice Handicap Index-10 (VHI-10), the Eating Assessment Tool-10 (EAT-10) and the Dyspnea Index (DI), and demographics were retrospectively extracted from patient medical records.

Results: Of 73 included study participants (40 OST, 24 PCT and 9 long-term intubated), 58% had visible laryngotracheal pathologies. Tracheostomy tube size and the number of days with tracheostomy were associated with skin and soft tissue pathology and tracheal pathology (p < 0.05). The results of the VHI-10 and EAT-10 were congruent with both laryngeal and skin and soft tissue pathologies. Participants with the highest DI scores, indicating breathing difficulties, had both laryngeal and tracheal pathologies followed by tracheal pathology alone.

Conclusions: A high incidence of visible laryngotracheal pathologies, two airway management-related factors, and symptom-pathology associations for VHI-10 and EAT-10 scores were found in a cohort of COVID-19 survivors ≥ 12 months after critical care.

FIGURE 1

Flow chart: Inclusion of study participants.

FIGURE 2

Factors associated with laryngotracheal and skin and soft tissue pathology. (A) percentage of participants with tracheal or laryngeal pathology. (B) days with tracheostomy. (C) percentage of participants requiring retracheotomy. (D) TT size. Mean with standard deviation is presented.

FIGURE 3

Reported subjective symptoms in the presence of or without tracheal (A), laryngeal (A, B), or skin and soft tissue (C) pathology. (A) Dyspnoea index (DI) as a measure of dyspnoea, (B) VHI‐10 as a measure of dysphonia, and C, EAT‐10 as a measure of dysphagia. (A, B) Median with upper and lower quartile (box), and mean (X) is presented. (C) Mean with standard deviation is presented.