OTO Open (Mar 2022)

Extensive Tracheal Injuries: A Reasoned Multistep Approach to Guarantee Mechanical Ventilatory Support Developed During the COVID-19 Pandemic

  • Francesco Mattioli MD, PhD,
  • Andrea Martone MD,
  • Alessandro Andreani MD,
  • Gaia Cappiello MD,
  • Roberto Tonelli MD,
  • Enrico Clini MD, PhD,
  • Alessandro Marchioni MD, PhD

DOI
https://doi.org/10.1177/2473974X221080446
Journal volume & issue
Vol. 6

Abstract

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The COVID-19 pandemic has notably increased the need for prolonged mechanical ventilation (MV) in patients with respiratory failure. This has increased the risk of extensive tracheal injury (ETI) associated with life-threatening complications in complex cases. Furthermore, tracheal injury treatment in patients with COVID-19 has not been described yet. Three patients with COVID-19 and ETI who required MV between April and November 2020 were included. A multistep approach was performed to restore tracheal integrity with a custom-remodeled stent and tracheostomy tube placement to allow ventilatory support. Efficient MV with no residual air leaks was obtained in all cases. One patient died 6 weeks after the procedure due to COVID-19 lung damage. Two patients have completely been weaned from MV. This multistep procedure could be used to maintain ventilatory support in the case of ETI, working as a bridge to subsequent surgery when clinical conditions improve.