Management of blind-end subglottic stenosis following SARS-CoV-2 infection: a case report

Abstract

Background: Reports identify rates of prolonged intubation as high as 28% in patients who are hospitalized for worsening respiratory status due the SARS-CoV-2 infection. This has placed a toll on healthcare systems around the world. However, we believe we are only seeing the beginnings of complications associated with the COVID-19 pandemic. Subglottic tracheal stenosis is a known complication of prolonged intubation and may therefore be on the rise in the wake of the current pandemic. The European Laryngology Society created the Laryngotracheal Stenosis Committee to alert the international medical community of the rise in airway complications associated with long-Term intubation and high rates of tracheostomy seen in the recent months during the pandemic. Optimal surgical management of the unique features of subglottic stenosis following COVID-19 disease, especially in severely deconditioned patients, has yet to be reported. Case Description: We report the surgical management of blind-end Myer-Cotton Grade IV subglottic stenoses in two patients who required prolonged mechanical ventilatory support for respiratory failure resulting from the SARS-CoV-2 infection with a two stage minimally invasive recanalization strategy. Patients underwent two-step minimally invasive process for recanalization. The first step is to re-establish a patent tracheal lumen under direct visualization utilizing both a rigid bronchoscope from proximally as well as a flexible bronchoscope distal to the stenosis from the tracheostomy stoma. Once the tracheal lumen is re-established, proper dilation of the airway and hemostasis is achieved in standard fashion. Both patients have had roughly 6 months of follow-up and have tolerated their silicone T-Tubes capped at all times. Neither patient currently require any oxygen supplementation and continue to phonate well. While they are not at their baseline in terms of physical activity, they are continuing their rehabilitation process. Conclusions: While the definitive treatment continues to be surgical resection, the endoscopic approach to re-establishing the tracheal lumen is a safe and effective method with little to no morbidity and mortality. This will allow for uninhibited rehabilitation following prolonged mechanical ventilatory support and hospital stay following severe COVID-19 infection. © 2022 Audiology and Speech Research. All rights reserved.