Management of Post COVID Tracheal Stenosis: A New Twist on an Old Problem

Since the advent of high volume, low pressure endotracheal tube cuffs, postintubation tracheal stenosis has become a rare event. Few centers have the experience or expertise to manage this difficult pathology safely and effectively. However, during the global coronavirus 2019 (COVID-19) pandemic, the global healthcare system was faced with a massive increase in critically ill patients suffering from respiratory failure. Often, these patients require prolonged mechanical ventilation and often prolonged orotracheal intubation. Thus, we are likely to see an increase in patients suffering from postintubation stenosis in the near future.

Dr. Ott and colleagues present the results of a group of patients who required tracheal resection for postintubation stenosis in the setting of previous severe COVID infection. As is the case with non-COVID tracheal resection patients, some had circuitous paths to the definitive diagnosis of tracheal stenosis. Two out of 4 had multiple bronchoscopic interventions prior to establishing the diagnosis.

The authors present impressive results, with no patients requiring mechanical ventilation postoperatively. The results illustrate the importance of institutional capabilities when dealing with these complex patients. The results also highlight the authors’ extensive experience with tracheal resection (and the management of possible resultant complications). For example, even in the small series there may be some advantage to the availability of hyperbaric oxygen treatment.

As center like this one gain more experience in tracheal resections after COVID pneumonia, it will be interesting to see if the findings of microvascular thrombi are routinely seen in this patient population, and whether they routinely corelate with pathologic findings.

This report serves as a reminder to all practitioners treating patients after severe covid infections to consider tracheal stenosis as a potential cause of persistent dyspnea. The number of patients with postintubation tracheal stenosis is likely to be significantly higher over the next few years as we emerge from a global pandemic. Although a small sample size, this report also highlights the need for these patients to be treated in centers of excellence with access to all necessary adjunctive therapies. It gives an early indication that these complex and difficult patients can be successfully managed surgically with tracheal resection and reconstruction.