Results
Six patients were hospitalized for tracheitis after total laryngectomy
and tested positive for Covid-19 during the reporting period. Five cases
were considered eligible and a retrospective analysis of their clinical
charts was performed. One patient was excluded for missing clinical
data. Detailed clinical and laboratory data regarding the patients is
reported in Table 1.
Mean age of patients was 75.2 years (SD=±7.3; range=64-82 years). Total
laryngectomy was performed on average 4 years (SD=±3.7; range=1-9 years)
before the present hospitalization. None of the patients had a speech
prosthesis. All patients were referred to the Emergency Room (ER) of our
Institution. The diagnosis of SARS-CoV-2 infection was in all cases
concomitant with the ER access. All patients presented with significant
Oxygen desaturation at the admission (considered as 02level < 90%), three patients had fever and cough, one had
thoracic pain and one had bleeding from the tracheostoma. In all cases a
prompt ENT assessment, including flexible fiberoptic evaluation through
the stoma was performed, allowing a diagnosis of tracheitis and
aspiration/removal of secretions or crusts. In all patients, a tracheal
cannula was positioned at admission. Five patients were hospitalized at
the Infectious Disease unit and one at the Pneumology unit. No patient
involved in the study needed recovery at the Intensive Care Unit (ICU),
except for patient #3 who had a brief ICU stay, concomitant with the
rapid deterioration of his conditions.
In four cases a pulmonary involvement was detected whereas in one case,
no signs or symptoms of pulmonary involvement were collected during the
hospital stay. Bubble-humidified oxygen was provided via mask over the
tracheostoma in all cases as well as aerosols administration of
mucolytics and hyaluronic acid solutions. In all cases intravenous
pharmacological therapy, including wide spectrum antibiotics and high
dose steroids, was administered. In 4 out of 5 cases anticoagulants were
also indicated.
In three patients, data of microbiologic analysis of the
tracheobronchial aspiration material was available, resulting in two
cases in a multiagent bacterial superinfection and no infection detected
in one case. In four patients, a serological assessment for testing
other respiratory viruses (Influenza A virus, Respiratory Syncytial
virus, Rhinoviruses, Parainfluenza viruses, Adenoviruses, Bocaviruses
and Metapneumovirus) was performed, with negative results.
All patients were evaluated daily by an otolaryngologist to assess the
degree of obstruction of the airway and possibly to remove secretions,
crusts and tracheobronchial plugs. Four patients showed variable degree
of haemorrhagic component of the tracheitis. In three cases a rigid
bronchoscopy was required for the management of the airway occlusion and
removal of distal bronchial plugs and blood clots (Figure 1). A tracheal
tissue sampling was collected in two cases and resulted in an erosive
inflammatory pattern at the histopathological analysis (Figure 2).
Four patients progressively improved their general conditions and were
discharged after a mean duration of the hospital stay of 32 days. One
patient died, 6 days after hospitalization, due to SARS-CoV-2
respiratory complications.