Onorati Ilaria, Bonnet Nicolas, Radu Dana Mihaela, Freynet Olivia, Guiraudet Patrice, Kambouchner Marianne, Uzunhan Yurdagul, Zogheib Elie, Martinod Emmanuel
Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France.
Department of Intensive Care Medicine, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France.
Front Surg. 2022 Apr 25;9:874077. doi: 10.3389/fsurg.2022.874077. eCollection 2022.
The novel Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), has spread rapidly to become a major global public health emergency since March 2020. Laryngotracheal stenosis (LTS) has been observed more frequently since the onset of the COVID-19 pandemic.
All patients referred to our 24/7 Airway Diseases Center for laryngotracheal post-intubation/tracheostomy stenosis from May 2020 to May 2021were evaluated retrospectively. Patient data on comorbidities, diagnosis, type of procedures, lengths of ICU stay and invasive mechanical ventilation, medical treatment, and the severity of illness were recorded.
This case series included nine patients (five women and four men), with a mean age of 52.9 years, most with a BMI >30, all with a severe illness revealed by the Simplified Acute Physiology Score (SAPS) II >31. From May 2020 to May 2021, 21 procedures were performed on seven patients, consisting of bronchoscopic rigid interventions, T-tube Montgomery tracheostomy, and one cricotracheal resection with end-to-end anastomosis. Histologic examination of tracheal biopsies showed an inflammatory state of the airway mucosa. Two patients only had medical therapy.
Pneumonia caused by SARSCoV-2 can lead to severe acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation. The time of intubation, the drugs used, the prone position, comorbidities (diabetes, obesity), and the inflammatory state of the upper airways linked to the viral infection, predispose to an increased tendency to stenosis and its recurrence. A conservative approach with medical and endoscopic treatment should be preferred in case of persistence of local airways inflammation. Further studies with a larger sample of patients will help to a better understanding of the disease, reduce the prevalence, and improve its treatment.
2019年新型冠状病毒病（COVID-19）由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起，自2020年3月以来迅速蔓延，成为全球重大公共卫生紧急事件。自COVID-19大流行开始以来，喉气管狭窄（LTS）的观察更为频繁。
对2020年5月至2021年5月期间转诊至我们全天候气道疾病中心的所有喉气管插管/气管切开术后狭窄患者进行回顾性评估。记录患者的合并症、诊断、手术类型、重症监护病房（ICU）住院时间和有创机械通气时间、药物治疗以及疾病严重程度等数据。
该病例系列包括9名患者（5名女性和4名男性），平均年龄52.9岁，大多数患者体重指数（BMI）>30，所有患者的简化急性生理学评分（SAPS）II均>31，表明病情严重。2020年5月至2021年5月期间，对7名患者进行了21次手术，包括支气管镜硬质干预、T型管蒙哥马利气管切开术以及1次环状气管切除术并端端吻合术。气管活检的组织学检查显示气道黏膜呈炎症状态。2名患者仅接受了药物治疗。
SARS-CoV-2引起的肺炎可导致严重急性呼吸窘迫综合征（ARDS），需要进行有创机械通气。插管时间、所用药物、俯卧位、合并症（糖尿病、肥胖）以及与病毒感染相关的上呼吸道炎症状态，均易导致狭窄倾向及其复发增加。对于局部气道炎症持续存在的情况，应优先采用药物和内镜治疗的保守方法。对更多患者样本进行进一步研究将有助于更好地了解该疾病，降低其患病率并改善治疗效果。
