Incidence of Laryngotracheal Lesions After Orotracheal Intubation in Coronavirus Disease Patients

<jats:sec><jats:title>Objectives/Hypothesis</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Study Design</jats:title><jats:p>Prospective cohort study.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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, <jats:sc>d</jats:sc>‐dimer, prothrombin time (PT), and international normalized ratio (INR) on the day OTI was performed.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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 <jats:sc>d</jats:sc>‐dimer, PT, and INR).</jats:p></jats:sec><jats:sec><jats:title>Level of Evidence</jats:title><jats:p>3 <jats:italic>Laryngoscope</jats:italic>, 132:1075–1081, 2022</jats:p></jats:sec>