Tracheal complications of mechanical ventilation for COVID-19: a plot twist for survivors

Severe COVID-19 patients require mechanical ventilation in up to 15.2% of cases [1]. Post-intubation tracheal stenosis (PITS), post-tracheostomy tracheal stenosis (PTTS) and trachea-oesophageal fistulas are tracheal complications of mechanical ventilation. The incidence of tracheal complications of mechanical ventilation was one in 200 000 patients annually before the COVID-19 pandemic [2]. The most important risk factors for these complications include prolonged mechanical ventilation, reintubation and excessive tracheal tube cuff pressure (>30 cmH2O), all of which were common in mechanically ventilated COVID-19 patients [3, 4]. We experienced a significant increase in referrals to our interventional pulmonology unit at a tertiary teaching hospital for PITS and PTTS treatment after the most severe COVID-19 surges, and thus conducted this retrospective study with prospective follow-up aiming to describe this unique cohort of patients. Tracheal complications should be suspected in mechanically ventilated COVID-19 survivors with respiratory symptoms. Treatment requires a multimodal approach of interventional bronchoscopy and surgery with tight follow-up due to a high rate of restenosis. https://bit.ly/3iw05xQ