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Vol. 88. Issue S2.
Pages 15 (November - December 2022)
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Vol. 88. Issue S2.
Pages 15 (November - December 2022)
Open Access
Risk factors for laryngotracheal injury in patients with COVID-19 submitted to orotracheal intubation
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Letícia Félix, Gabriel de Souza Mares, Lara Freire Bezerril Soares, Sérgio Roberto Nacif, Romualdo Suzano Louzeiro Tiago
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romualdotiago@uol.com.br

Corresponding author.
Serviço de Otorrinolaringologia do Hospital do Servidor Público Estadual de São Paulo “Francisco Morato de Oliveira” (HSPE-FMO)/Setor de Laringologia e Cirurgia Cervicofacial, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo (IAMSPE), São Paulo, SP, Brazil
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Vol. 88. Issue S2
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Objective: To evaluate the risk factors for the development of laryngotracheal lesions patients with COVID-19 undergoing orotracheal intubation (IOT).

Method: A prospective cohort was evaluated and approved by the Research Ethics Committee of the institution. Consecutive patients diagnosed with COVID-19 were evaluated for molecular test of RT-PCR, hospitalized in a tertiary hospital, in the period of March 1 to 31 October 2020, who required IOT. Patients who were discharged were called for outpatient follow-up and examination of the endoscopic.

Results: 1357 patients diagnosed with COVID-19 were hospitalized confirmed by molecular rt-PCR test in a nasal swab. IOT for ventilation mechanics was required in 421 patients (31%). In patients undergoing IOT, the outcome found was: hospital discharge – 172 (40.9%); death – 249 (59.1%). The evaluation outpatient videoendoscopy was performed in 95 patients (55.2%), on average 100 days after extubation. Statistical significance was observed for the development of laryngotracheal lesion patients who presented at the time of hospital admission the following factors: increase in leukocyte count (leukocytosis) with a reduction in lymphocyte count (lymphopenia), hypoalbuminemia, increased arterial lactate, increased troponin and increased total bilirubin; size of the endotracheal tube; indication of pronation during the IOT period; and increased leukocyte count, D-dimer, TP and INR on the date of IOT.

Conclusions: We observed a higher risk for the development of laryngotracheal injury patients who presented at hospital admission the increase in the leukocytes (leukocytosis) with reduced lymphocyte count (lymphopenia), hypoalbuminemia, increased arterial lactate, increased troponin and increased total bilirubin. Patients who used a larger endotracheal tube and were submitted to the pronation position, as well as patients who at the time of IOT increased inflammatory reactivity (increase in leukocyte count) or developed coagulation disorders (increased D-dimer, TP and INR), at higher risk for the development of laryngotracheal injury.

Keywords: COVID-19; SARS-CoV-2; Laryngotracheal susthesis after intubation; Larynx.

Brazilian Journal of Otorhinolaryngology (English Edition)
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