Hernández-García Estefanía, Hernández-Sandemetrio Rosa, Quintana-Sanjuás Ana, Zapater-Latorre Enrique, González-Herranz Ramón, Sanz Lorena, Reboll Rosa, Pallarés-Martí Beatriz, Ollé-Moliner Montserrat, Martínez-Pascual Paula, Gotxi Itziar, Chacón-Uribe Araly, Plaza Guillermo
Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain.
Department of Otorhinolaryngology, Hospital General Universitario, 46014 Valencia, Spain.
Life (Basel). 2023 May 18;13(5):1207. doi: 10.3390/life13051207.
Many of the patients with COVID-19 have suffered respiratory distress requiring prolonged endotracheal intubation (ETI) resulting in laryngotracheal complication with an impact on breathing, phonation, and swallowing. Our aim is to describe laryngeal injuries diagnosed after ETI in patients with COVID-19 in a multicentre study.
A prospective descriptive observational study was conducted from January 2021 to December 2021, including COVID-19 patients with laryngeal complications due to ETI diagnosed in several Spanish hospitals. We analyzed the epidemiological data, previous comorbidities, mean time to ICU admission and ETI, need for tracheostomy, mean time on invasive mechanical ventilation until tracheostomy or weaning, mean time in ICU, type of residual lesions, and their treatment.
We obtained the collaboration of nine hospitals during the months of January 2021 to December 2021. A total of 49 patients were referred. Tracheostomy was performed in 44.9%, being late in most cases (more than 7-10 days). The mean number of days of ETI until extubation was 17.63 days, and the main post-intubation symptoms were dysphonia, dyspnea, and dysphagia, in 87.8%, 34.7%, and 42.9%, respectively. The most frequent injury was altered laryngeal mobility, present in 79.6%. Statistically, there is a greater amount of stenosis after late ETI and after delayed tracheostomy, not observing the data with the immobility alterations.
The mean number of days of ETI was long, according to the latest guidelines, with the need for several cycles of pronation. This long ETI may have had an impact on the increase of subsequent laryngeal sequelae, such as altered laryngeal mobility or stenosis.
许多新冠肺炎患者出现呼吸窘迫，需要长时间气管插管（ETI），导致喉气管并发症，影响呼吸、发声和吞咽。我们的目的是在一项多中心研究中描述新冠肺炎患者ETI后诊断出的喉部损伤。
2021年1月至2021年12月进行了一项前瞻性描述性观察研究，纳入在几家西班牙医院诊断出因ETI导致喉部并发症的新冠肺炎患者。我们分析了流行病学数据、既往合并症、入住重症监护病房（ICU）和进行ETI的平均时间、气管切开术的需求、直到气管切开术或脱机的有创机械通气平均时间、在ICU的平均时间、残余病变类型及其治疗情况。
在2021年1月至2021年12月期间获得了9家医院的合作。共转诊49例患者。44.9%的患者进行了气管切开术，大多数情况下为晚期（超过7 - 10天）。ETI至拔管的平均天数为17.63天，插管后的主要症状分别为声音嘶哑、呼吸困难和吞咽困难，发生率分别为87.8%、34.7%和42.9%。最常见的损伤是喉活动度改变，发生率为79.6%。从统计学上看，晚期ETI和延迟气管切开术后狭窄的发生率更高，未观察到与活动度改变相关的数据。
根据最新指南，ETI的平均天数较长，需要进行多个俯卧位通气周期。这种长时间的ETI可能对随后喉部后遗症的增加产生了影响，如喉活动度改变或狭窄。
