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Fiorelli A, Pecoraro A, Failla G, Blasio FD, Rendina EA, Venuta F, Andreetti C. Endoscopic Management of Benign Airway Stenosis in Coronavirus Disease 2019 Patients. Thorac Cardiovasc Surg 2024; 72:320-325. [PMID: 37072114 DOI: 10.1055/a-2075-8109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND The aims of this study were to evaluate the results of endoscopic dilation for simple benign airway stenosis in coronavirus disease 2019 (COVID-19) patients and whether COVID-19 infection was associated with higher rate of recurrence compared with a control group. METHODS It was an observational multicenter study including consecutive patients with simple benign airway stenosis undergoing endoscopic dilatation with at least 6 months of follow-up. The outcome of patients with COVID-19 infection was compared with that of a control group in relation to patient and stenosis characteristics, and procedure type. Then, univariable and multivariable analyses identified the risk factors for recurrence. RESULTS Seventy-nine patients were included in the study; 56 (71%) of these developed airway stenosis after COVID-19 infection. COVID-19 patients presented a higher rate of stenosis due to prolonged intubation (82 vs. 43%; p = 0.0014); no other differences were found regarding demographic data, characteristics of stenosis, and procedure type. Twenty-four (30%) patients had recurrence after first dilatation (32% for No-COVID-19 vs. 26% for COVID-19 group; p = 0.70), and in 11 (35%) of these, the stenosis recurred after repeated endoscopic treatment (65% for No-COVID-19 vs. 45% for COVID-19 group; p = 0.40). Subglottic stenosis (p = 0.013) and the use of laser (p = 0.016) were significant predictive factors for stenosis recurrence. CONCLUSION COVID-19 infection did not affect the outcome of endoscopic treatment of simple airway stenosis, and the treatment of these subsets of patients should not differ from that of general population.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Giuseppe Failla
- Bronchoscopy Unit, Ospedale Cardarelli, Napoli, Campania, Italy
| | - Francesco De Blasio
- Respiratory Medicine and Pulmonary Rehabilitation Unit, Clinic Center, Naples, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery Unit, Università degli Studi di Roma La Sapienza, Rome, Lazio, Italy
| | - Federico Venuta
- Thoracic Surgery Unit, Università degli Studi di Roma La Sapienza, Rome, Lazio, Italy
| | - Claudio Andreetti
- Thoracic Surgery Unit, Università degli Studi di Roma La Sapienza, Rome, Lazio, Italy
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Menna C, Fiorelli S, Marinucci BT, Massullo D, D'Andrilli A, Ciccone AM, Andreetti C, Maurizi G, Vanni C, Siciliani A, Tiracorrendo M, Mancini M, Venuta F, Rendina EA, Ibrahim M. New perspectives on tracheal resection for COVID-19-related stenosis: A propensity score matching analysis. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00282-4. [PMID: 38555996 DOI: 10.1016/j.jtcvs.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE The large number of patients with COVID-19 subjected to prolonged invasive mechanical ventilation has been expected to result in a significant increase in tracheal stenosis in the next years. The aim of this study was to evaluate and compare postoperative outcomes of patients who survived COVID-19 critical illness and underwent tracheal resection for postintubation/posttracheostomy tracheal stenosis with those of non-COVID-19 patients. METHODS It was single-center, retrospective study. All consecutive patients with post-intubation/posttracheostomy tracheal stenosis who underwent tracheal resection from February 2020 to March 2022 were enrolled. A total of 147 tracheal resections were performed: 24 were in post-COVID-19 patients and 123 were in non-COVID-19 patients. A 1:1 propensity score matching analysis was performed, considering age, gender, body mass index, and length of stenosis. After matching, 2 groups of 24 patients each were identified: a post-COVID-19 group and a non-COVID group. RESULTS No mortality after surgery was registered. Posttracheostomy etiology of stenosis resulted more frequently in post-COVID-19 patients (n = 20 in the post-COVID-19 group vs n = 11 in the non-COVID-19 group; P = .03), as well as intensive care unit admissions during the postoperative period (16 vs 9 patients; P = .04). Need for postoperative reintubation for glottic edema and respiratory failure was higher in the post-COVID-19 group (7 vs 2 postoperative reintubation procedures; P = .04). Postoperative dysphonia was observed in 11 (46%) patients in the post-COVID-19 group versus 4 (16%) patients in the non-COVID-19 group (P = .03). CONCLUSIONS Tracheal resection continues to be safe and effective in COVID-19-related tracheal stenosis scenarios. Intensive care unit admission rates and postoperative complications seem to be higher in post-COVID-19 patients who underwent tracheal resection compared with non-COVID-19 patients.
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Affiliation(s)
- Cecilia Menna
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Silvia Fiorelli
- Division of Anesthesiology and Intensive Care, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Domenico Massullo
- Division of Anesthesiology and Intensive Care, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio D'Andrilli
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Ciccone
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Claudio Andreetti
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giulio Maurizi
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Camilla Vanni
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alessandra Siciliani
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Matteo Tiracorrendo
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Mancini
- Morphologic and Molecular Pathology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Federico Venuta
- Division of Thoracic Surgery, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Fiacchini G, Abel JR, Tricò D, Ribechini A, Canelli R, Picariello M, Guarracino F, Forfori F, Dallan I, Berrettini S, Bruschini L. Incidence and types of laryngotracheal sequelae of prolonged invasive ventilation in COVID-19 patients. Eur Arch Otorhinolaryngol 2022; 279:5755-5760. [PMID: 35661918 PMCID: PMC9166245 DOI: 10.1007/s00405-022-07467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/23/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE The COVID-19 outbreak has led to an increasing number of acute laryngotracheal complications in patients subjected to prolonged mechanical ventilation, but their incidence in the short and mid-term after ICU discharge is still unknown. The main objective of this study is to evaluate the incidence of these complications in a COVID-19 group of patients and to compare these aspects with non-COVID-19 matched controls. METHODS In this cohort study, we retrospectively selected patients from November 1 to December 31, 2020, according to specific inclusion and exclusion criteria. The follow-up visits were planned after 6 months from discharge. All patients were subjected to an endoscopic evaluation and completed two questionnaires (VHI-10 score and MDADI score). RESULTS Thirteen men and three women were enrolled in the COVID-19 group while nine men and seven women were included in the control group. The median age was 60 [56-66] years in the COVID-19 group and 64 [58-69] years in the control group. All the patients of the control group showed no laryngotracheal lesions, while five COVID-19 patients had different types of lesions, two located in the vocal folds and three in the trachea. No difference was identified between the two groups regarding the VHI-10 score, while the control group showed a significantly worse MDADI score. CONCLUSIONS COVID-19 patients subjected to prolonged invasive ventilation are more likely to develop a laryngotracheal complication in the short and medium term. A rigorous clinical follow-up to allow early identification and management of these complications should be set up after discharge.
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Affiliation(s)
- Giacomo Fiacchini
- Otolaryngology, Audiology and Phoniatric Operative UnitDepartment of Surgical, Medical and Molecular Pathology and Critical Care MedicineAzienda Ospedaliero-Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2, 56124 Pisa, Italy
| | - Joel Reuben Abel
- Otolaryngology, Audiology and Phoniatric Operative UnitDepartment of Surgical, Medical and Molecular Pathology and Critical Care MedicineAzienda Ospedaliero-Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2, 56124 Pisa, Italy
| | - Domenico Tricò
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | - Rachele Canelli
- Otolaryngology, Audiology and Phoniatric Operative UnitDepartment of Surgical, Medical and Molecular Pathology and Critical Care MedicineAzienda Ospedaliero-Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2, 56124 Pisa, Italy
| | - Miriana Picariello
- Otolaryngology, Audiology and Phoniatric Operative UnitDepartment of Surgical, Medical and Molecular Pathology and Critical Care MedicineAzienda Ospedaliero-Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2, 56124 Pisa, Italy
| | - Fabio Guarracino
- Cardiothoracic and Vascular Anaesthesia and Intensive Care, Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
| | - Francesco Forfori
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Iacopo Dallan
- Otolaryngology, Audiology and Phoniatric Operative UnitDepartment of Surgical, Medical and Molecular Pathology and Critical Care MedicineAzienda Ospedaliero-Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2, 56124 Pisa, Italy
| | - Stefano Berrettini
- Otolaryngology, Audiology and Phoniatric Operative UnitDepartment of Surgical, Medical and Molecular Pathology and Critical Care MedicineAzienda Ospedaliero-Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2, 56124 Pisa, Italy
| | - Luca Bruschini
- Otolaryngology, Audiology and Phoniatric Operative UnitDepartment of Surgical, Medical and Molecular Pathology and Critical Care MedicineAzienda Ospedaliero-Universitaria Pisana (AOUP), University of Pisa, Via Paradisa, 2, 56124 Pisa, Italy
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