{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T06:34:46Z","timestamp":1782887686436,"version":"3.54.5"},"reference-count":52,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,9,18]],"date-time":"2021-09-18T00:00:00Z","timestamp":1631923200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>To evaluate the incidence of lesions and severe sequelae and the risk factors for the development of laryngotracheal lesions after orotracheal intubation (OTI) in coronavirus disease (COVID\u201019) patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Prospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this prospective cohort study, we evaluated patients diagnosed with COVID\u201019 who were consecutively admitted to a tertiary hospital and required OTI from March 1, 2020 to October 31, 2020. Patients discharged were called for outpatient follow\u2010up and endoscopic examination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1,357 patients diagnosed with COVID\u201019, as confirmed by nasal swab reverse transcription polymerase chain reaction, were admitted. OTI for mechanical ventilation was required in 421 patients (31%). Of the intubated patients, 172 (40.9%) were discharged and 249 (59.1%) died. Outpatient evaluation by videoendoscopy was performed in 95 patients (55.2%) approximately 100\u2009days after extubation. Laryngotracheal lesions were observed in 38 patients (40%), with 17.9% diagnosed with laryngotracheal stenosis or unilateral immobility while 6.3% had severe stenosis (grades 3 and 4). The factors presenting statistical significance for the development of laryngotracheal lesions were the endotracheal tube (ETT) size; prone position over the OTI period; and the increased leukocyte count, <jats:sc>d<\/jats:sc>\u2010dimer, prothrombin time (PT), and international normalized ratio (INR) on the day OTI was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The incidence of laryngotracheal lesion in COVID\u201019 patients is 40%, with 6.3% of them presenting with severe stenosis. There was a greater risk for the development of laryngotracheal lesions in patients using a larger ETT, kept in a prone position, presenting a greater inflammatory reaction (increased leukocyte count), or developing coagulation disorders (increased <jats:sc>d<\/jats:sc>\u2010dimer, PT, and INR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>3 <jats:italic>Laryngoscope<\/jats:italic>, 132:1075\u20131081, 2022<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.29862","type":"journal-article","created":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T13:40:43Z","timestamp":1631540443000},"page":"1075-1081","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Incidence of Laryngotracheal Lesions After Orotracheal Intubation in Coronavirus Disease Patients"],"prefix":"10.1002","volume":"132","author":[{"given":"Let\u00edcia","family":"F\u00e9lix","sequence":"first","affiliation":[{"name":"Otorhinolaryngology Service, Department of Laryngology and Cervicofacial Surgery S\u00e3o Paulo State Civil Servants Hospital \u2010 FMO\/IAMSPE  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy L.","family":"Tavares","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology Service, Department of Laryngology and Cervicofacial Surgery S\u00e3o Paulo State Civil Servants Hospital \u2010 FMO\/IAMSPE  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinicius P. B.","family":"Almeida","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology Service, Department of Laryngology and Cervicofacial Surgery S\u00e3o Paulo State Civil Servants Hospital \u2010 FMO\/IAMSPE  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2451-0526","authenticated-orcid":false,"given":"Romualdo S. L.","family":"Tiago","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology Service, Department of Laryngology and Cervicofacial Surgery S\u00e3o Paulo State Civil Servants Hospital \u2010 FMO\/IAMSPE  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,9,18]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00020840-200312000-00011"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.1585"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000004830"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003368"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aem005"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000000279"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-005-0929-y"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0892-1997(98)80026-x"},{"key":"e_1_2_7_10_1","first-page":"1","article-title":"Prolonged endotracheal intubation","volume":"33","author":"Lindholm CE","year":"1970","journal-title":"Acta Anaesthesiol Scand Suppl"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.1983.93.10.1314"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198512000-00005"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2020.102432"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.594832"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.1992.tb02121.x"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200305000-00005"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0034-70942006000200011"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-020-06112-6"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/019459988008800625"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-199212000-00004"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.5812\/ircmj.37574"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.14639\/0392-100X-N0884"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/lio2.484"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004554"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004015"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15054"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.0780"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50598"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-009-9158-y"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2012.05.007"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.4097\/kjae.2015.68.1.27"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-021-06664-1"},{"key":"e_1_2_7_33_1","first-page":"341","article-title":"Prevention of postintubation laryngotracheal stenosis","volume":"49","author":"Ferdinande P","year":"1995","journal-title":"Acta Otorhinolaryngol Belg"},{"key":"e_1_2_7_34_1","article-title":"Evaluating the knowledge of endotracheal cuff pressure monitoring among critical care providers by palpation of pilot balloon and by endotracheal tube cuff manometer","volume":"11","author":"Abubaker J","year":"2019","journal-title":"Cureus"},{"key":"e_1_2_7_35_1","volume-title":"StatPearls","author":"Ahmed RA","year":"2021"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10877-020-00501-2"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-017-4838-7"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-020-05993-x"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.0764"},{"key":"e_1_2_7_40_1","first-page":"e583","article-title":"COVIDTrach; the outcomes of mechanically ventilated COVID\u201019 patients undergoing tracheostomy in the UK: interim report","volume":"107","author":"COVIDTrach collaborative","year":"2020","journal-title":"Br J Surg."},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40463-020-00414-9"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2020.104844"},{"key":"e_1_2_7_43_1","article-title":"Severe COVID\u201019: understanding the role of immunity, endothelium, and coagulation in clinical practice","volume":"19","author":"Brand\u00e3o SCS","year":"2020","journal-title":"J Vasc Bras"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30434-5"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30937-5"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-0968-3"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2020.05.007"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2020006000"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.4148"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00011-020-01401-6"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14820"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30566-3"},{"key":"e_1_2_7_53_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.4517"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.29862","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lary.29862","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.29862","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T23:33:12Z","timestamp":1692487992000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.29862"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,18]]},"references-count":52,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.1002\/lary.29862"],"URL":"https:\/\/doi.org\/10.1002\/lary.29862","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,18]]},"assertion":[{"value":"2021-05-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-08-28","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-09-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}