10.14639/0392-100X-N0884
application/xml
1827-675X
884
6
en
Pasquale Capaccio
https://creativecommons.org/licenses/by-nc-nd/4.0
ACTA Otorhinolaryngologica Italica
laryngeal stenosis
Looking at the day after COVID-19… what laryngeal sequelae should we expect?
Text.Serial.Journal
https://www.actaitalica.it/
40
Letters to the Editor-in-Chief
2020-09-24
2020-05-26
2021-01-21
2021-01-21
466-468
1
Pasquale Capaccio
2020/09/24
10.14639/0392-100X-N0884
466
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Department of Biomedical Surgical Dental Science, Milan, Italy
1827-675X
6
laryngeal stenosis
468
Looking at the day after COVID-19… what laryngeal sequelae should we expect?
https://www.actaitalica.it/article/download/884/381
40
ACTA OTORHINOLARYNGOLOGICA ITALICA 2020;40:466-468; doi: 10.14639/0392-100X-N0884




Letter to the Editor


Looking at the day after COVID-19…
what laryngeal sequelae should we expect?
Guardando all’era post COVID-19… quali sequele laringee dobbiamo attenderci?
Sara Torretta1,2, Lorenzo Maria Gaini1, Michele Gaffuri1, Lorenzo Pignataro1,2, Remo Accorona1, Pasquale Capaccio1,3
1
 Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 2 Università degli Studi di Milano, Department of Clinical
Sciences and Community Health, Milan, Italy; 3 Università degli Studi di Milano, Department of Biomedical Surgical Dental Science,
Milan, Italy


KEY WORDS: SARS-CoV-2, coronavirus, COVID-19, tracheotomy, dysphagia, laryngeal
stenosis
PAROLE CHIAVE: SARS-CoV-2, coronavirus, COVID-19, tracheotomia, disfagia, stenosi
laringee


Dear Editor,
airway management is crucial in effective treatment of COVID-19 patients with
critical/severe disease. In the literature, the risk of nosocomial SARS-CoV-2
transmission ascribable to increased request for tracheostomy continues to be           Received: May 26, 2020
debated 1,2; in addition, we have to take into account that, once the acute phase       Accepted: June 9, 2020
passes, we may have to face other problems, such as laryngo-tracheal sequelae           Published online: September 24, 2020
following prolonged endotracheal intubation and tracheostomy 3. Now that
                                                                                        Correspondence
infectious spreading and contagion has been steadily decreasing in Italy, we            Sara Torretta
observed an escalation in requests for ENT consultation for laryngeal complaints        Department of Clinical Sciences and Community
in COVID-19 patients who underwent endotracheal intubation or tracheostomy,             Health, Università degli Studi di Milano,
                                                                                        Fondazione IRCCS Ca’ Granda Ospedale Maggiore
independently of age, and were able to overcome the critical stage of disease at our    Policlinico, via F. Sforza 35, 20122 Milano, Italy
frontline hospital in Milan, located in epicentre of the Italian COVID-19 epidemic.     Tel. +39 02 50320245. Fax +39 02 50320248
Several factors could be responsible for a remarkable prevalence of laryngeal           E-mail: sara.torretta@unimi.it
dysfunction in post-acute COVID-19 patients:
                                                                                        Funding
• more time needed for respiratory weaning resulting in prolonged endotracheal          None.
   intubation/tracheostomy maintenance to continuous positive airway pressure
   ventilation;                                                                         Conflict of interest
• the use of high-pressure ventilation to treat acute respiratory distress syndrome;    The Authors declare no conflict of interest.
• Adoption of surgical and anaesthesiologic protocols aimed at reducing dispersal
   of infected aerosols during/after endotracheal intubation and tracheostomy             How to cite this article: Torretta S, Gaini LM,
                                                                                          Gaffuri M, et al. Looking at the day after CO-
   performance 1,2, such as: the use of non-fenestrated and cuffed tubes with             VID-19… what laryngeal sequelae should we ex-
   adequate cuff inflation, reduction/avoidance of tracheostomy change 1,2;               pect? Acta Otorhinolaryngol Ital 2020;40:466-
• poor pulmonary performance and hypoxaemia with increased respiratory rate,              468. https://doi.org/10.14639/0392-100X-N0884
   negatively affecting the respiration/swallowing balance;
                                                                                        © Società Italiana di Otorinolaringoiatria
• a possible reduced cortical/subcortical laryngeal coordination due to peripheral      e Chirurgia Cervico-Facciale
   and/or central SARS-CoV-2 neuroinvasive propensity through a synapse-
   connected route 4,5, suspected on the grounds of documented neurological                            OPEN ACCESS

   complaints and smell impairment 4.                                                   This is an open access article distributed in accordance with
                                                                                        the CC-BY-NC-ND (Creative Commons Attribution-Non-
On one hand, this scenario results in perpetuation of mucosal trauma and                Commercial-NoDerivatives 4.0 International) license. The
mechanical lesions/scaring leading to reduced laryngo-tracheal patency. On the          article can be used by giving appropriate credit and mentio-
                                                                                        ning the license, but only for non-commercial purposes and
other hand, laryngeal/hypopharyngeal sensation as well as airway protection             only in the original version. For further information: https://
are reduced; muscle weakness and atrophy related to disuse and critical illness         creativecommons.org/licenses/by-nc-nd/4.0/deed.en




466
                                                                                                              Laryngeal sequelae in the post-COVID-19 era




myopathy and neuropathy with impairment in coordination of                      and applied only to urgent cases 7-9, and optimising non-
respiration/swallowing pattern may occur and predispose to                      instrumental swallowing assessment tools as an alternative to
swallowing disorders 6.                                                         fiberoptic endoscopic evaluation is difficult to carry out in a
In the post-COVID era, we must be prepared to deal with                         short-time period. All of this may cause further difficulties in
an increased prevalence of patients with laryngo-tracheal                       management.
sequelae, and to adequately manage them, also considering                       A proposed follow-up schedule to be considered by ENT
that the therapeutic approach can be troublesome and                            specialists for post-critical assessment of COVID-19 patients
outcomes are not always predictable. In addition, traditional                   with documented or suspected laryngeal sequelae after
diagnostic and rehabilitative pathways have been reconsidered                   intensive care management is presented in Figure 1.




Figure 1. Proposal of a follow-up schedule for post-critical assessment of COVID-19 patients with documented or suspected laryngeal sequelae after intensive
care management.



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S. Torretta et al.




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