Incidence of Laryngotracheal Lesions After Orotracheal Intubation in Coronavirus Disease Patients

Félix, Letícia; Tavares, Tracy L; Almeida, Vinicius P B; Tiago, Romualdo S L

OBJECTIVES/HYPOTHESIS: 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. STUDY DESIGN: Prospective cohort study. 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, 2020 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 reverse transcription polymerase chain reaction, 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 (ETT) 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 ETT, kept in a prone position, presenting a greater inflammatory reaction (increased leukocyte count), or developing coagulation disorders (increased d-dimer, PT, and INR). LEVEL OF EVIDENCE: 3 Laryngoscope, 2021.