PDF(Pubmed)
Abstract：
OBJECTIVE: Occurrence of post-intubation laryngotracheal stenosis (LTS) with respect to COVID-19 status.
METHODS: Retrospective cross-sectional inpatient database.
METHODS: Eleven Midwest academic and community hospitals, United States.
METHODS: Adults, mechanically ventilated, from January 2020 to August 2022, who were subsequently readmitted within 6 months with a new diagnosis of LTS.
METHODS: None.
RESULTS: Six thousand eight hundred fifty-one COVID-19 negative and 1316 COVID-19 positive patients were intubated and had similar distribution by age (median 63.77 vs. 63.16 yr old), sex (male, 60.8%; n = 4173 vs. 60%; n = 789), endotracheal tube size (≥ 7.5, 75.8%; n = 5192 vs. 75.5%; n = 994), and comorbidities. The ICU length of stay (median [interquartile range (IQR)], 7.23 d [2.13-16.67 d] vs. 3.95 d [1.91-8.88 d]) and mechanical ventilation days (median [IQR], 5.57 d [1.01-14.18 d] vs. 1.37 d [0.35-4.72 d]) were longer in the COVID-19 positive group. The occurrence of LTS was double in the COVID-19 positive group (12.7%, n = 168 vs. 6.4%, n = 440; p < 0.001) and was most commonly diagnosed within 60 days of intubation. In multivariate analysis, the risk of LTS increased by 2% with each additional ICU day (hazard ratio [HR], 1.02; 95% CI, 1.02-1.03; p < 0.001), by 3% with each additional day of ventilation (HR, 1.03; 95% CI, 1.02-1.04; p < 0.001), and by 52% for each additional reintubation (HR, 1.52; 95% CI, 1.36-1.71; p < 0.001). We observed no significant association COVID-19 status and risk of LTS.
CONCLUSIONS: The occurrence of post-intubation LTS was double in a COVID-19 positive cohort, with higher risk with increasing number of days intubated, days in the ICU and especially with the number of reintubations. COVID-19 status was not an independent risk factor for LTS.
METHODS: Retrospective cross-sectional inpatient database.
METHODS: Eleven Midwest academic and community hospitals, United States.
METHODS: Adults, mechanically ventilated, from January 2020 to August 2022, who were subsequently readmitted within 6 months with a new diagnosis of LTS.
METHODS: None.
RESULTS: Six thousand eight hundred fifty-one COVID-19 negative and 1316 COVID-19 positive patients were intubated and had similar distribution by age (median 63.77 vs. 63.16 yr old), sex (male, 60.8%; n = 4173 vs. 60%; n = 789), endotracheal tube size (≥ 7.5, 75.8%; n = 5192 vs. 75.5%; n = 994), and comorbidities. The ICU length of stay (median [interquartile range (IQR)], 7.23 d [2.13-16.67 d] vs. 3.95 d [1.91-8.88 d]) and mechanical ventilation days (median [IQR], 5.57 d [1.01-14.18 d] vs. 1.37 d [0.35-4.72 d]) were longer in the COVID-19 positive group. The occurrence of LTS was double in the COVID-19 positive group (12.7%, n = 168 vs. 6.4%, n = 440; p < 0.001) and was most commonly diagnosed within 60 days of intubation. In multivariate analysis, the risk of LTS increased by 2% with each additional ICU day (hazard ratio [HR], 1.02; 95% CI, 1.02-1.03; p < 0.001), by 3% with each additional day of ventilation (HR, 1.03; 95% CI, 1.02-1.04; p < 0.001), and by 52% for each additional reintubation (HR, 1.52; 95% CI, 1.36-1.71; p < 0.001). We observed no significant association COVID-19 status and risk of LTS.
CONCLUSIONS: The occurrence of post-intubation LTS was double in a COVID-19 positive cohort, with higher risk with increasing number of days intubated, days in the ICU and especially with the number of reintubations. COVID-19 status was not an independent risk factor for LTS.
摘要：
目的：插管后喉气管狭窄（LTS）的发生与COVID-19状态有关。
方法：回顾性横断面住院患者数据库。
方法：中西部11所学术和社区医院，美国。
方法：成人，机械通风,从2020年1月至2022年8月，他们随后在6个月内重新入院，新诊断为LTS。
方法：无。
结果：接受了680051例COVID-19阴性和1316例COVID-19阳性患者的插管，其年龄分布相似（中位数为63.77vs.63.16岁)，性别（男性，60.8%；n=4173vs.60%；n=789），气管导管尺寸（≥7.5，75.8%；n=5192vs.75.5%；n=994），和合并症。ICU住院时间（中位数[四分位距（IQR）]，7.23d[2.13-16.67d]vs.3.95d[1.91-8.88d])和机械通气天数(中位数[IQR]，5.57d[1.01-14.18d]vs.COVID-19阳性组的1.37d[0.35-4.72d]）更长。在COVID-19阳性组中，LTS的发生率是两倍（12.7%，n=168vs.6.4%,n=440；p<0.001），最常见于插管后60天内。在多变量分析中，ICU每增加一天，LTS的风险增加2%(危险比[HR]，1.02；95%CI，1.02-1.03；p<0.001），每增加一天的通气次数为3%(HR，1.03；95%CI，1.02-1.04；p<0.001），每增加一次再插管的52%(HR，1.52；95%CI，1.36-1.71；p<0.001)。我们观察到COVID-19状态和LTS风险没有显著关联。
结论：在COVID-19阳性队列中，插管后LTS的发生率是两倍，随着插管天数的增加，风险更高，在ICU中的天数，尤其是重新插管的次数。COVID-19状态不是LTS的独立危险因素。
方法：回顾性横断面住院患者数据库。
方法：中西部11所学术和社区医院，美国。
方法：成人，机械通风,从2020年1月至2022年8月，他们随后在6个月内重新入院，新诊断为LTS。
方法：无。
结果：接受了680051例COVID-19阴性和1316例COVID-19阳性患者的插管，其年龄分布相似（中位数为63.77vs.63.16岁)，性别（男性，60.8%；n=4173vs.60%；n=789），气管导管尺寸（≥7.5，75.8%；n=5192vs.75.5%；n=994），和合并症。ICU住院时间（中位数[四分位距（IQR）]，7.23d[2.13-16.67d]vs.3.95d[1.91-8.88d])和机械通气天数(中位数[IQR]，5.57d[1.01-14.18d]vs.COVID-19阳性组的1.37d[0.35-4.72d]）更长。在COVID-19阳性组中，LTS的发生率是两倍（12.7%，n=168vs.6.4%,n=440；p<0.001），最常见于插管后60天内。在多变量分析中，ICU每增加一天，LTS的风险增加2%(危险比[HR]，1.02；95%CI，1.02-1.03；p<0.001），每增加一天的通气次数为3%(HR，1.03；95%CI，1.02-1.04；p<0.001），每增加一次再插管的52%(HR，1.52；95%CI，1.36-1.71；p<0.001)。我们观察到COVID-19状态和LTS风险没有显著关联。
结论：在COVID-19阳性队列中，插管后LTS的发生率是两倍，随着插管天数的增加，风险更高，在ICU中的天数，尤其是重新插管的次数。COVID-19状态不是LTS的独立危险因素。
