PDF(Pubmed)
Abstract：
Background: Tracheal stenosis represents a fearsome complication that substantially impairs quality of life. The recent SARS-CoV-2 pandemic increased the number of patients requiring invasive ventilation through prolonged intubation or tracheostomy, increasing the risk of tracheal stenosis. Study design and methods: In this prospective, observational, multicenter study performed in Lombardy (Italy), we have exanimated 281 patients who underwent prolonged intubation (more than 7 days) or tracheostomy for severe COVID-19. Patients underwent CT scan and spirometry 2 months after hospital discharge and a subsequent clinical follow-up after an additional 6 months (overall 8 months of follow-up duration) to detect any tracheal lumen reduction above 1%. The last follow-up evaluation was completed on 31 August 2022. Results: In the study period, 24 patients (8.5%, CI 5.6-12.4) developed tracheal stenosis in a median time of 112 days and within a period of 200 days from intubation. Compared to patients without tracheal stenosis, tracheostomy was performed more frequently in patients that developed stenosis (75% vs 54%, p = 0.034). Tracheostomy and alcohol consumption (1 unit of alcohol per day) increased risk of developing tracheal stenosis of 2.6-fold (p = 0.047; IC 0.99-6.8) and 5.4-fold (p = 0.002; CI 1.9-16), respectively. Conclusions: In a large cohort of patients, the incidence of tracheal stenosis increased during pandemic, probably related to the increased use of prolonged intubation. Patients with histories of prolonged intubation should be monitored for at least 200 days from invasive ventilation in order to detect tracheal stenosis at early stage. Alcohol use and tracheostomy are risk factors for developing tracheal stenosis.
摘要：
背景：气管狭窄是一种可怕的并发症，严重损害了生活质量。最近的SARS-CoV-2大流行增加了需要通过长时间插管或气管造口术进行有创通气的患者数量，增加气管狭窄的风险。研究设计和方法：在这一前瞻性中，观察,在伦巴第（意大利）进行的多中心研究，我们治愈了281例因严重COVID-19而接受长时间插管(超过7天)或气管造口术的患者.患者在出院后2个月接受CT扫描和肺活量测定，并在另外6个月（总体随访时间为8个月）后进行后续临床随访，以检测任何气管腔减少超过1％。最后一次后续评估于2022年8月31日完成。结果：在研究期间，24名患者（8.5%，CI5.6-12.4）在插管后的中位时间112天和200天内出现气管狭窄。与没有气管狭窄的患者相比，在发生狭窄的患者中，气管造口术的频率更高（75％vs54％，p=0.034)。气管造口术和饮酒（每天1单位酒精）使发生气管狭窄的风险增加2.6倍（p=0.047；IC0.99-6.8）和5.4倍（p=0.002；CI1.9-16），分别。结论：在一大群患者中，大流行期间气管狭窄的发生率增加，可能与长时间插管的使用增加有关。有长期插管史的患者应在有创通气后至少监测200天，以便在早期发现气管狭窄。饮酒和气管造口术是发生气管狭窄的危险因素。
