Tracheal Stenosis and Airway Complications in the Coronavirus Disease 2019 Era

Abstract

BackgroundSevere coronavirus disease 2019 (COVID-19) infection is associated with prolonged intubation and its complications. Tracheal stenosis is 1 such complication that may require specialized surgical management. We aimed to describe the surgical management of post–COVID-19 tracheal stenosis. MethodsThis case series describes consecutive patients with tracheal stenosis from intubation for severe COVID-19 infection at our single, tertiary academic medical center between January 1, 2021, and December 31, 2021. Patients were included if they underwent surgical management with tracheal resection and reconstruction (TRR) or bronchoscopic intervention. Operative through 6-month symptom-free survival and histopathologic analysis of resected trachea were reviewed. ResultsEight patients are included in this case series. All patients are female, and most (87.5%) are obese. Five patients (62.5%) underwent TRR; 3 patients (38.5%) underwent non–resection-based management. Among patients who underwent TRR, 6-month symptom-free survival is 80%; 1 patient (20%) required tracheostomy after TRR for recurrent symptoms. Of the 3 patients who underwent non–resection-based management, 2 (66.7%) experienced durable relief from symptoms of tracheal stenosis with tracheal balloon dilation; the remaining patient required laser excision of tracheal tissue before experiencing symptomatic relief. ConclusionsThe incidence of tracheal stenosis may increase as patients recover from severe COVID-19 infection requiring intubation. Management of tracheal stenosis with TRR is safe and effective, with comparable rates of success to TRR for non–COVID-19 tracheal stenosis. Non–resection-based management is an option to manage tracheal stenosis in patients with less severe stenosis or in poor surgical candidates.