Incidence of Laryngotracheal Lesions After Orotracheal Intubation in Coronavirus Disease Patients

Objectives/Hypothesis To evaluate the incidence of lesions and severe sequelae and the risk factors for the development of laryngotracheal lesions after orotracheal intubation (OTI) in coronavirus disease (COVID‐19) patients. Study Design Prospective cohort study. Methods In this prospective cohort study, we evaluated patients diagnosed with COVID‐19 who were consecutively admitted to a tertiary hospital and required OTI from March 1, 2020 to October 31, 2020. Patients discharged were called for outpatient follow‐up and endoscopic examination. Results A total of 1,357 patients diagnosed with COVID‐19, as confirmed by nasal swab reverse transcription polymerase chain reaction, were admitted. OTI for mechanical ventilation was required in 421 patients (31%). Of the intubated patients, 172 (40.9%) were discharged and 249 (59.1%) died. Outpatient evaluation by videoendoscopy was performed in 95 patients (55.2%) approximately 100 days after extubation. Laryngotracheal lesions were observed in 38 patients (40%), with 17.9% diagnosed with laryngotracheal stenosis or unilateral immobility while 6.3% had severe stenosis (grades 3 and 4). The factors presenting statistical significance for the development of laryngotracheal lesions were the endotracheal tube (ETT) size; prone position over the OTI period; and the increased leukocyte count, d‐dimer, prothrombin time (PT), and international normalized ratio (INR) on the day OTI was performed. Conclusions The incidence of laryngotracheal lesion in COVID‐19 patients is 40%, with 6.3% of them presenting with severe stenosis. There was a greater risk for the development of laryngotracheal lesions in patients using a larger ETT, kept in a prone position, presenting a greater inflammatory reaction (increased leukocyte count), or developing coagulation disorders (increased d‐dimer, PT, and INR). Level of Evidence 3 Laryngoscope, 132:1075–1081, 2022