{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T08:55:33Z","timestamp":1770713733818,"version":"3.49.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T00:00:00Z","timestamp":1680220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>An increasing number of patients have been subjected to prolonged invasive mechanical ventilation due to COVID-19 infection, leading to a significant number of post-intubation\/tracheostomy (PI\/T) upper airways lesions. The purpose of this study is to report our early experience in endoscopic and\/or surgical management of PI\/T upper airways injuries of patients surviving COVID-19 critical illness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>We prospectively collected data from patients referred to our Thoracic Surgery Unit from March 2020 to February 2022. All patients with suspected or documented PI\/T tracheal injuries were evaluated with neck and chest computed tomography and bronchoscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirteen patients (8 males, 5 females) were included; of these, 10 (76.9%) patients presented with tracheal\/laryngotracheal stenosis, 2 (15.4%) with tracheoesophageal fistula (TEF) and 1 (7.7%) with concomitant TEF and stenosis. Age ranged from 37 to 76 years. Three patients with TEF underwent surgical repair by double layer suture of oesophageal defect associated with tracheal resection\/anastomosis (1 case) or direct membranous tracheal wall suture (2\u00a0cases) and protective tracheostomy with T-tube insertion. One patient underwent redo-surgery after primary failure of oesophageal repair. Among 10 patients with stenosis, two (20.0%) underwent primary laryngotracheal resection\/anastomosis, two (20.0%) had undergone multiple endoscopic interventions before referral to our Centre and, at arrival, one underwent emergency tracheostomy and T-tube positioning and one a removal of a previously positioned endotracheal nitinol stent for stenosis\/granulation followed by initial laser dilatation and, finally, tracheal resection\/anastomosis. Six (60.0%) patients were initially treated with rigid bronchoscopy procedures (laser and\/or dilatation). Post-treatment relapse was experienced in 5 (50.0%) cases, requiring repeated rigid bronchoscopy procedures in 1 (10.0%) for definitive resolution of the stenosis and surgery (tracheal resection\/anastomosis) in 4 (40.0%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Endoscopic and surgical treatment is curative in the majority of patients and should always be considered in PI\/T upper airways lesions after COVID-19 illness.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2023.1150254","type":"journal-article","created":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T08:44:54Z","timestamp":1680252294000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Not only acute respiratory failure: COVID-19 and the post-intubation\/tracheostomy upper airways 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