Prevalence of laryngotracheal lesions in tracheostomized COVID-19 patients. A comparison with a matched historical control group of non-COVID-19 patients

Figures & data

Table 1. Patient demographics.

Variable	Post-COVID-19 (n = 49)	Non-COVID-19 (n = 49)	P value
Age (median, [IQR 25–75])	64 [52–70]	66 [55–71]	0.511
Female (n,%)	16 (32.7)	16 (32.7)	1.000
Charlson score (median, [IQR 25–75])	1 [0–3]	2 [0–5]	0.063
Days of OTI (median, [IQR 25–75])	18 [14.5–22]	16 [13-]21]	0.209
Tracheostomy tube inner diameter at admission (median, [IQR 25–75])	8 [8]	8 [8–8.5]	0.207
Full tracheostomy tube change (median, [IQR 25–75])	1 [0–3]	3 [2–7]	<0.001
Background
Neurological (n,%)	4 (8.2)	15 (30.6)	0.009
● Stroke (n,%)	0 (0)	6 (12.2)	0.027
Cardiovascular (n,%)	24 (49)	29 (59.2)	0.418
● High blood pressure (n,%)	24 (49)	27 (55.1)	0.686
Respiratory (n,%)	10 (20.4)	16 (32.7)	0.252
● Chronic obstructive pulmonary disease (n,%)	1 (2)	13 (26.5)	0.001
Metabolic (n,%)	30 (61.2)	17 (34.7)	0.015
- Obesity (BMI >30 kg/m^2) (n,%)	19 (38.8)	4 (8.2)	0.001
- Renal failure (n,%)	3 (6.1)	2 (4.1)	1.000
● Diabetes mellitus (n,%)	10 (20.4)	9 (18.4)	0.416
Oncological (n,%)	2 (4.1)	9 (18.4)	0.051
Reasons for IMV
-Coma (n,%)	0 (0)	4 (8.16%)	0.060
-ARF (n,%)	50 (100)	17 (34.69%)
-CRF (n,%)	0 (0)	24 (48.97%)
-Neuromuscular (n,%)	0 (0)	4 (8.16%)
Laboratory parameters at SWC admission
Albumin, g/dL (median, [IQR 25–75])	2.8 [2.6–3.2]	2.9 [2.5–3.2]	0.963
Creatinine, mg/dL (median, [IQR 25–75])	0.6 [0.5–0.8]	0.7 [0.6–2.2]	0.330
Hemoglobin, g/dL (median, [IQR 25–75])	9.2 [8.1–10]	9.4 [8.5–10.5]	0.325
TSH, uUl/ml (median, [IQR 25–75])	1.69 [0.91–3.24]	2.21 [1.11–3.47]	0.384
Medical condition at SWC admission and progress
Admitted to SWC with IMV (n, %)	26 (53.1)	28 (57.1)	0.839

References: (ARF) acute respiratory failure: Presence of arterial hypoxemia (PaO2 less than 60 mmHg), at rest, at sea level and breathing room air, accompanied or not by hypercapnia (PaCO2 greater than 45 mmHg), (CRF) chronic respiratory failure, [IQR] interquartile range 25–75, (TSH) thyroid-stimulating hormone, (IMV) invasive mechanical ventilation, (SWC) specialized weaning center, (AA) artificial airway.

Figure 1. Classification of laryngotracheal injuries according to diagnosis and severity during FFB.

References: (FFB) flexible fiberoptic bronchoscopy.

Table 2. Type and severity of airway lesions in matched post-COVID-19 and non-COVID patients.

Variable	Post-COVID-19 (n = 49)	Non-COVID-19 (n = 49)	p value
Pathological bronchoscopy (n, %)	26 (53.1)	36 (73.5)	0.036^†
Excessive central airway collapse (n, %)	13 (26.5)	11 (22.4)	0.638^†
Stenosis (n, %)	1 (2.0)	2 (4.1)	1.000^α
Granuloma (n, %)	17 (34.7)	30 (61.2)	0.009^†
Lesion obstructing above 50% of the lumen (n, %)	6/26 (23.1)	10/36 (27.8)	0.676^†

^†Chi-square Test.

^αFisher´s exact Test.

Table 3. Classification of airway lesions based on localization in matched post-COVID-19 patients and non-COVID-19 patients.

Lesion type	Localization	Post-COVID-19 (n = 49)	Non-COVID-19 (n = 49)	p value
Collapse (n, %)	Without injury	36 (75.0)	38 (77.6)	0.267
	Subglottic	6 (12.5)	2 (4.1)
	Tracheal	6 (12.5)	9 (18.4)
Stenosis (n, %)	Without injury	48 (98)	47 (95.9)	0.603
	Subglottic	1 (2.0)	1 (2.0)
	Bronchial	0 (0.0)	1 (2.0)
Granuloma (n, %)	Without injury	32 (65,3)*	19 (38,8)*	0.019
	Subglottic	16 (32.7)	24 (49.0)
	Stoma	0 (0.0)*	5 (10.2)*
	Tracheal	1 (2.0)	1 (2.0)

*Comparison of proportions between columns significative.

Figure 2. Analysis the post-COVID-19 group based on the period of SWC admission.

Hernández-García E, Hernández-Sandemetrio R, Quintana-Sanjuás A, et al. Laryngotracheal complications after intubation for COVID-19: a multicenter study. Life. 2023 May 18;13(5):1207. doi: 10.3390/life13051207

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Planells F, Villalba D, Viviana F, et al. Prevalence and Characteristics of Tracheal lesions Observed in tracheostomized patients. J Bronchology Interv Pulmonol. 2019 Apr;26(2):119–123. doi: 10.1097/LBR.0000000000000538

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