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.