Evaluation of the Incidence and Potential Mechanisms of Trac
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Full-thickness tracheal lesions and tracheoesophageal fistulas are severe complications of invasive mechanical ventilation. The incidence of tracheal complications in ventilated patients with coronavirus disease 2019 (COVID-19) is unknown.

To evaluate whether patients with COVID-19 have a higher incidence of full-thickness tracheal lesions and tracheoesophageal fistulas than matched controls and to investigate potential mechanisms a study was conducted.

A retrospective cohort study was done in patients admitted to the intensive care unit in a tertiary referral hospital. Among 98 consecutive patients with COVID-19 with severe respiratory failure, 30 underwent prolonged invasive mechanical ventilation and were included in the COVID-19 group. The control group included 45 patients without COVID-19. Patients with COVID-19 were selected from March 1 to May 31, 2020, while the control group was selected from March 1 to May 31, 2019. Patients with COVID-19 had severe acute respiratory syndrome coronavirus 2 infection diagnosed by nasopharyngeal/oropharyngeal swabs and were treated according to local therapeutic procedures.

The primary study outcome was the incidence of full-thickness tracheal lesions or tracheoesophageal fistulas in patients with prolonged invasive mechanical ventilation.

The mean age was 68.8 (9.0) years in the COVID-19 group and 68.5 (14.1) years in the control group. Eight and 15 women were enrolled in the COVID-19 group and the control group, respectively. Fourteen patients (47%) in the COVID-19 group had full-thickness tracheal lesions ( 33%) or tracheoesophageal fistulas (13%), while 1 patient (2.2%) in the control group had a full-thickness tracheal lesion (odds ratio, 38.4). Clinical and radiological presentations of tracheal lesions were pneumomediastinum (n?=?10), pneumothorax (n?=?6), and/or subcutaneous emphysema (n?=?13).

In this cohort study, almost half of patients with COVID-19 developed full-thickness tracheal lesions and/or tracheoesophageal fistulas after prolonged invasive mechanical ventilation. Attempts to prevent these lesions should be made and quickly recognized when they occur to avoid potentially life-threatening complications in ventilated patients with COVID-19.

Source: https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2772875
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