ABSTRACT
BACKGROUND Severe Coronavirus Disease 2019 (COVID-19) infection is associated with prolonged intubation and its complications. Tracheal stenosis is one such complication that may require specialized surgical management. We aimed to describe the surgical management of post-COVID-19 tracheal stenosis. METHODS This case series describes consecutive patients with tracheal stenosis from intubation for severe COVID-19 infection at our single, tertiary academic medical center between January 1st, 2021, and December 31st, 2021. Patients were included if they underwent surgical management with tracheal resection and reconstruction, or bronchoscopic intervention. Operative through six-month, symptom-free survival and histopathological analysis of resected trachea were reviewed. RESULTS Eight patients are included in this case series. All patients are female, and most (87.5%) are obese. Five patients (62.5%) underwent tracheal resection and reconstruction (TRR), while three patients (38.5%) underwent non-resection-based management. Among patients who underwent TRR, six-month symptom free survival is 80%;one patient (20%) required tracheostomy after TRR due to recurrent symptoms. Two of the three (66.7%) of patients who underwent non-resection-based management experienced durable relief from symptoms of tracheal stenosis with tracheal balloon dilation, and the remaining patient required laser excision of tracheal tissue prior to experiencing symptomatic relief. CONCLUSIONS The incidence of tracheal stenosis may increase as patients recover from severe COVID-19 infection requiring intubation. Management of tracheal stenosis with TRR is safe and effective, with comparable rates of success to TRR for non-COVID-19 tracheal stenosis. Non-resection-based management is an option to manage tracheal stenosis in patients with less severe stenosis or in poor surgical candidates.
ABSTRACT
Purpose: This study assessed changes in speech-language pathology practice 1 year following the onset of the COVID-19 pandemic. The specific focus was on speech-language pathologists (SLPs) engaged in evaluation and treatment activities that pose an increased risk of virus transmission, namely, aerosol-generating procedures. Method: SLPs from the United States and Canada (n = 609) who were engaged in clinical activities with an elevated risk of COVID-19 exposure completed an online survey regarding their clinical practices. Topics assessed included continuation, modification, or cessation of clinical services, personal protective equipment (PPE) use, COVID-19 infections and vaccinations among SLPs, and financial impacts. For comparison, the results from the 2020 survey are included, and the percentage change (2020% - 2021%) is reported. Results: A majority of SLPs (90%) who completed the current survey reported that they were not experiencing PPE shortages, a marked change from the 2020 survey. Over half of the SLPs (52%) reported changes in clinical duties in 2021, with in-person visits and endoscopy being the most impacted. Nearly half of the respondents (49%) reported conducting virtual/telehealth clinical activities during the pandemic, and of these, 78% had not done any virtual/telehealth work prior to COVID-19. A positive COVID-19 test was reported by 10% of the SLPs (5% higher than in 2020). Most SLPs (92%) indicated they were vaccinated at the time of this survey. Conclusions: The 2021 survey data indicated an overall increase in SLP clinical activities compared with 2020 but have not yet returned to prepandemic levels. These results highlight a notable uptake of virtual/telehealth practice by SLPs, including those who had not previously done so. SLP vaccination rates also exceeded that of the general population.
ABSTRACT
Head and neck cancer patients with tracheostomies and laryngectomies, as well as their healthcare providers, face unique challenges in the context of the current COVID-19 pandemic. This document consolidates best available evidence to date and presents recommendations to minimize the risks of aerosolization and SARS-CoV-2 exposures in both the inpatient and outpatient settings. The cornerstones of these recommendations include the use of closed-circuit ventilation whenever possible, cuffed tracheostomy tubes, judicious use of heat moisture exchange units, appropriate personal protective equipment for providers and patients, meticulous hand hygiene, and minimal manipulation of tracheostomy tubes.