Mangiameli Giuseppe, Perroni Gianluca, Costantino Andrea, De Virgilio Armando, Malvezzi Luca, Mercante Giuseppe, Giudici Veronica Maria, Ferraroli Giorgio Maria, Voulaz Emanuele, Giannitto Caterina, Acocella Fabio, Onorati Ilaria, Martinod Emmanuel, Cariboni Umberto
Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy.
J Pers Med. 2023 Apr 26;13(5):729. doi: 10.3390/jpm13050729.
Benign subglottic/tracheal stenosis (SG/TS) is a life-threatening condition commonly caused by prolonged endotracheal intubation or tracheostomy. Invasive mechanical ventilation was frequently used to manage severe COVID-19, resulting in an increased number of patients with various degrees of residual stenosis following respiratory weaning. The aim of this study was to compare demographics, radiological characteristics, and surgical outcomes between COVID-19 and non-COVID patients treated for tracheal stenosis and investigate the potential differences between the groups.
We retrospectively retrieved electronical medical records of patients managed at two referral centers for airways diseases (IRCCS Humanitas Research Hospital and Avicenne Hospital) with tracheal stenosis between March 2020 and May 2022 and grouped according to SAR-CoV-2 infection status. All patients underwent a radiological and endoscopic evaluation followed by multidisciplinary team consultation. Follow-up was performed through quarterly outpatient consultation. Clinical findings and outcomes were analyzed by using SPPS software. A significance level of 5% ( < 0.05) was adopted for comparisons.
A total of 59 patients with a mean age of 56.4 (±13.4) years were surgically managed. Tracheal stenosis was COVID related in 36 (61%) patients. Obesity was frequent in the COVID-19 group (29.7 ± 5.4 vs. 26.9 ± 3, = 0.043) while no difference was found regarding age, sex, number, and types of comorbidities between the two groups. In the COVID-19 group, orotracheal intubation lasted longer (17.7 ± 14.5 vs. 9.7 ± 5.8 days, = 0.001), tracheotomy (80%, = 0.003) as well as re-tracheotomy (6% of cases, = 0.025) were more frequent and tracheotomy maintenance was longer (21.5 ± 11.9 days, = 0.006) when compared to the non-COVID group. COVID-19 stenosis was located more distal from vocal folds (3.0 ± 1.86 vs. 1.8 ± 2.03 cm) yet without evidence of a difference ( = 0.07). The number of tracheal rings involved was lower in the non-COVID group (1.7 ± 1 vs. 2.6 ± 0.8 = 0.001) and stenosis were more frequently managed by rigid bronchoscopy (74% vs. 47%, = 0.04) when compared to the COVID-19 group. Finally, no difference in recurrence rate was detected between the groups (35% vs. 15%, = 0.18).
Obesity, a longer time of intubation, tracheostomy, re-tracheostomy, and longer decannulation time occurred more frequently in COVID-related tracheal stenosis. These events may explain the higher number of tracheal rings involved, although we cannot exclude the direct role of SARS-CoV-2 infection in the genesis of tracheal stenosis. Further studies with in vitro/in vivo models will be helpful to better understand the role of inflammatory status caused by SARS-CoV-2 in upper airways.
良性声门下/气管狭窄（SG/TS）是一种危及生命的疾病，通常由长期气管插管或气管切开术引起。有创机械通气常用于治疗重症COVID-19，导致呼吸脱机后不同程度残余狭窄的患者数量增加。本研究的目的是比较因气管狭窄接受治疗的COVID-19患者和非COVID患者的人口统计学、放射学特征及手术结果，并研究两组之间的潜在差异。
我们回顾性检索了2020年3月至2022年5月期间在两家气道疾病转诊中心（IRCCS胡马纳塔斯研究医院和阿维森纳医院）接受治疗的气管狭窄患者的电子病历，并根据是否感染严重急性呼吸综合征冠状病毒2（SAR-CoV-2）进行分组。所有患者均接受了放射学和内镜评估，随后进行了多学科团队会诊。通过每季度的门诊会诊进行随访。使用SPSS软件分析临床发现和结果。比较采用的显著性水平为5%（<0.05）。
共有59例平均年龄为56.4（±13.4）岁的患者接受了手术治疗。36例（61%）患者的气管狭窄与COVID-19相关。COVID-19组肥胖患者较多（29.7±5.4 vs. 26.9±3，P = 0.043），而两组在年龄、性别、合并症数量和类型方面未发现差异。在COVID-19组中，经口气管插管持续时间更长（17.7±14.5天 vs. 9.7±5.8天，P = 0.001），气管切开术（80%，P = 0.003）以及再次气管切开术（6%的病例，P = 0.025）更常见，且与非COVID组相比，气管切开术维持时间更长（21.5±11.9天，P = 0.006）。COVID-19相关狭窄距声带的位置更远（3.0±1.86 cm vs. 1.8±2.03 cm），但无差异证据（P = 0.07）。非COVID组累及的气管环数量较少（1.7±1 vs. 2.6±0.8，P = 0.001），与COVID-19组相比，采用硬质支气管镜治疗狭窄更为频繁（74% vs. 47%，P = 0.04）。最后，两组之间未检测到复发率差异（35% vs. 15%，P = 0.18）。
肥胖、更长的插管时间、气管切开术、再次气管切开术以及更长的拔管时间在COVID-19相关气管狭窄中更频繁出现。这些情况可能解释了累及气管环数量较多的原因，尽管我们不能排除SARS-CoV-2感染在气管狭窄发生中的直接作用。进一步开展体外/体内模型研究将有助于更好地理解SARS-CoV-2引起的炎症状态在上呼吸道中的作用。
