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10.1001/jamaoto.2020.4148

http://scihub22266oqcxt.onion/10.1001/jamaoto.2020.4148
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33211087!7677875!33211087
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suck abstract from ncbi


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pmid33211087      JAMA+Otolaryngol+Head+Neck+Surg 2021 ; 147 (1): 70-76
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  • Evaluation of the Incidence and Potential Mechanisms of Tracheal Complications in Patients With COVID-19 #MMPMID33211087
  • Fiacchini G; Trico D; Ribechini A; Forfori F; Brogi E; Lucchi M; Berrettini S; Bertini P; Guarracino F; Bruschini L
  • JAMA Otolaryngol Head Neck Surg 2021[Jan]; 147 (1): 70-76 PMID33211087show ga
  • IMPORTANCE: Full-thickness tracheal lesions and tracheoesophageal fistulas are severe complications of invasive mechanical ventilation. The incidence of tracheal complications in ventilated patients with coronavirus disease 2019 (COVID-19) is unknown. OBJECTIVE: To evaluate whether patients with COVID-19 have a higher incidence of full-thickness tracheal lesions and tracheoesophageal fistulas than matched controls and to investigate potential mechanisms. DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective cohort study in patients admitted to the intensive care unit in a tertiary referral hospital. Among 98 consecutive patients with COVID-19 with severe respiratory failure, 30 underwent prolonged (>/=14 days) invasive mechanical ventilation and were included in the COVID-19 group. The control group included 45 patients without COVID-19. Patients with COVID-19 were selected from March 1 to May 31, 2020, while the control group was selected from March 1 to May 31, 2019. EXPOSURES: Patients with COVID-19 had severe acute respiratory syndrome coronavirus 2 infection diagnosed by nasopharyngeal/oropharyngeal swabs and were treated according to local therapeutic procedures. MAIN OUTCOMES AND MEASURES: The primary study outcome was the incidence of full-thickness tracheal lesions or tracheoesophageal fistulas in patients with prolonged invasive mechanical ventilation. RESULTS: The mean (SD) age was 68.8 (9.0) years in the COVID-19 group and 68.5 (14.1) years in the control group (effect size, 0.3; 95% CI, -5.0 to 5.6). Eight (27%) and 15 (33%) women were enrolled in the COVID-19 group and the control group, respectively. Fourteen patients (47%) in the COVID-19 group had full-thickness tracheal lesions (n = 10, 33%) or tracheoesophageal fistulas (n = 4, 13%), while 1 patient (2.2%) in the control group had a full-thickness tracheal lesion (odds ratio, 38.4; 95% CI, 4.7 to 316.9). Clinical and radiological presentations of tracheal lesions were pneumomediastinum (n = 10, 71%), pneumothorax (n = 6, 43%), and/or subcutaneous emphysema (n = 13, 93%). CONCLUSIONS AND RELEVANCE: In this cohort study, almost half of patients with COVID-19 developed full-thickness tracheal lesions and/or tracheoesophageal fistulas after prolonged invasive mechanical ventilation. Attempts to prevent these lesions should be made and quickly recognized when they occur to avoid potentially life-threatening complications in ventilated patients with COVID-19.
  • |Aged[MESH]
  • |COVID-19/epidemiology/*therapy[MESH]
  • |Female[MESH]
  • |Humans[MESH]
  • |Male[MESH]
  • |Pneumonia, Viral/epidemiology/*therapy/virology[MESH]
  • |Respiration, Artificial/*adverse effects[MESH]
  • |Retrospective Studies[MESH]
  • |Risk Factors[MESH]
  • |SARS-CoV-2[MESH]


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