Effect of COVID-19 on the incidence of postintubation laryngeal lesions

Abstract

Background

Critically ill patients intubated in the intensive care unit experience prolonged intubation leading to increased frequency of laryngeal injuries. This study aimed to demonstrate a suspected increase in vocal fold injury in patients who were intubated with COVID-19 as compared with patients intubated for other reasons.

Methods

A retrospective review of medical records was performed to identify patients examined using flexible endoscopic evaluation of swallowing exams. The study included 25 patients with COVID-19 and 27 without COVID-19 at Baylor Scott & White Medical Center in Temple, Texas. Various injuries were evaluated, ranging from granulation tissue to vocal cord paralysis. Severe lesions were those causing clinically significant airway obstruction or requiring operative intervention. The incidence of laryngeal injury in patients intubated for COVID-19 was then compared with that of patients intubated for other reasons.

Results

The increased presence of severe injury in COVID-positive patients appeared clinically significant but was not statistically significant (P = 0.06). Interestingly, patients who received pronation therapy had 4.6 times the odds of more severe injury compared with patients who did not (P = 0.009).

Conclusion

Lower thresholds for performing flexible laryngoscopy on postintubated patients who are proned may allow for earlier intervention and reduce morbidity in an already at-risk population.

Keywords:

• Acute respiratory distress syndrome
• COVID
• flexible endoscopic evaluation of swallowing
• laryngeal injury
• posterior glottic stenosis
• pronation
• subglottic stenosis
• vocal cord injury

ACKNOWLEDGMENTS

The authors would like to acknowledge Kendall Hammonds, statistician at Baylor Scott & White in Temple, Texas, for her support and contributions to the statistical analysis of our results.

Disclosure statement

The authors report no funding or conflicts of interest.