Evaluation of the Trachea and Bronchi in COVID-19 Patients Using the 3-dimensional Reconstruction Method.

OBJECTIVE: To evaluate changes in the trachea and bronchi of COVID-19 patients using the 3-dimensional reconstruction images obtained from chest CT (computed tomography) scans. STUDY DESIGN: An observational study. Place and Duration of the Study: Departments of Anatomy and Radiology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey, between March 2021 and January 2022. METHODOLOGY: There were 150 COVID-19 patients in the acute period and 150 individuals as the control group. The CT images were transferred to Mimics software, and a 3-dimensional reconstruction was performed. COVID-19 patients were grouped separately by gender, and their total lung severity score was classified as absent (Grade 0), mild (Grade 1), moderate (Grade 2), and severe (Grade 3). RESULTS: The cross-sectional area and diameter of the right upper lobar bronchus decreased as the grade increased (p<0.05 and p<0.001, respectively). The circumference of the right upper lobar bronchus and the cross-sectional area and circumference of the left lower lobar bronchus were found to be narrower in Grade 1-2-3 COVID-19 patients compared to those of the control group (p<0.01, p<0.05, and p<0.05, respectively). The cross-sectional area, circumference, and diameter of the middle lobar bronchus were found to be narrower in Grade 3 COVID-19 patients (p<0.05, p<0.05, and p<0.05, respectively). CONCLUSION: Although mostly independent of the grade increase, narrowing of the trachea and bronchi was observed in COVID-19 patients in the acute period. Further research is required with to reveal whether the narrowings are permanent. KEY WORDS: COVID-19, Trachea, Bronchus, 3-dimensional reconstruction.

A challenging case of tracheal foreign body retrieval following COVID-19 swabbing.

The COVID-19 pandemic has resulted in a significant increase in the number of tracheostomised patients in hospitals requiring ventilatory support. These patients require highly specialist care, but overwhelmed hospital systems with stretched human resources potentially leave these patients cared for by undertrained healthcare professionals. We describe a rare complication where a routine COVID-19 swab done incorrectly via a tracheostomy tube, resulted in a snapped-off swab in the trachea. We outline the events and our method of removal using rigid bronchoscopy through the tracheostomy stoma as endo-tracheal bronchoscopy was impossible due to significant sub-glottic stenosis. This case highlights the paramount importance of the unique care needed to safely manage tracheostomies during this ongoing pandemic.

Iatrogenic tracheal rupture in a patient with acute respiratory distress syndrome due to SARS-CoV-2 pneumonia.

Iatrogenic tracheal rupture (ITR) is a serious complication secondary to procedures such as emergent orotracheal intubation or tracheostomy, among others. The management of ITR depends on the size, extension and location of the injury, along with the patient's respiratory status and comorbidities. The priority of treatment is to keep the airway permeable to ensure adequate ventilation. We present the case of a tracheal rupture after performing a percutaneous tracheostomy, in a patient diagnosed with severe acute respiratory distress syndrome secondary to bilateral interstitial pneumonia due to SARS-Cov-2. The issues are discussed, such as the management (conservative vs. surgical) depending on the features of the injury and the patient, in the extraordinary context that the COVID-19 pandemic has entailed.

The evaluation of the trachea as a new parameter in determining the prognosis of COVID-19: first pilot study.

OBJECTIVE: Coronavirus disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) follows a biphasic disease model consisting of an early viral response phase and an inflammation phase. SARS-CoV-2 has a high affinity for the upper respiratory tract and conjunctiva; hence, it can infect the upper respiratory tract and facilitate airway inflammation. COVID-19 also affects the tracheal epithelial cells. We hypothesized that the size of the trachea increases depending on the severity of the disease, and this increase is an indicator of poor prognosis. There are no studies on this subject in literature, to the best of our knowledge. For this purpose, in this study, the tracheas of 326 patients who reported to the radiology clinic were examined by evaluating the thoracic computed tomography (CT) images. PATIENTS AND METHODS: The patients who were admitted to the Malatya Training and Research Hospital between September and December 2020, had a positive SARS-CoV-2 nasopharyngeal reverse transcription-polymerase chain reaction result, and had undergone thoracic CT, were included in the study. The thoracic CT scans without respiratory artifacts were evaluated, and anteroposterior (AP) and transverse diameters of the trachea were measured at the thyroid and bifurcation levels. RESULTS: We believe that a tracheal AP diameter of >20 mm at the thyroid level and a tracheal AP diameter of 18 mm at the thyroid bifurcation level (according to Group 3 and Group 4) may be indicators of poor prognosis. In terms of survival, a tracheal AP diameter of >18 mm at the bifurcation level can be considered as a poor prognostic factor. CONCLUSIONS: The tracheal diameter may increase in proportion to the severity of inflammation, indicating or accompanying a poor prognosis. Patients with extensive involvement should be monitored closely for the development of tracheal stenosis.

Two Cases of Post-intubation Laryngotracheal Stenosis Occurring after Severe COVID-19.

We experienced two cases of post-intubation laryngotracheal stenosis (PILS) occurring in patients after acute coronavirus disease (COVID)-19 in a relatively narrow time period. The patients required mechanical ventilation for 9 days in one and 28 days in the other. In both cases, the patients were discharged but later developed symptoms of cough and dyspnea, which were later diagnosed as PILS. Persistent cough and dyspnea are common symptoms in both PILS and the recovery phase of severe COVID-19. For this reason, PILS should be considered in the differential diagnosis post-COVID-19 patients. In addition, the prevalence of PILS may be greater than that of other critical diseases in severe COVID-19 patients.