hiv testing

wastewater_70896

tracheostomy

subglottic

tracheotomy

dtpa

markov chain

bacterial_78970

knob

tracheal stenosis

airway_112760

neurectomy

extremely low birth

subcutaneous emphysema

tracheal_38553

land reform_43908

pause

severe hypoxemia

Journal of Clinical Nursing

As the COVID-19 pandemic has swept across the globe, the dominant narrative about overwhelmed inpatient settings obscured a more nuanced crisis—the rising prevalence of occult airway injuries among survivors. Up to 90% of patients admitted to intensive care units undergo intubation and invasive mechanical ventilation, often requiring tracheostomy. Resulting device-related airway pressure injuries are disturbingly common, affecting over 50% of individuals. Endotracheal and tracheostomy tubes may cause a wide range of laryngotracheal injuries, from mucosal ulceration to destruction of cartilage or even transmural injury, causing stenosis—all with profound quality of life ramifications (Brodsky, Akst, et al., 2020; Brodsky et al., 2020). Nurses are uniquely positioned to expedite diagnosis and intervention, improving voice, swallowing and breathing. Laryngotracheal stenosis (LTS), the most common long-term complication of acute airway injury, involves a partial or complete narrowing of the airway lumen at the level of the larynx, subglottic space or trachea. The narrowest part of the normal adult airway is the subglottic space, which is the most common site of tracheal stenosis. Prior to the pandemic, up to 9% of patients requiring invasive mechanical ventilation experienced stenosis. In the COVID-19 era, this rate has risen due to trauma associated with decreased visualisation when using personal protective gear, cuff overinflation and prolonged intubation (Hillel et al., 2016). COVID-19 patients have a median ventilation duration of 17 days and a high frequency of re-intubation. In addition, prone positioning, pressure of endotracheal tube cuff/tracheostomy tube and larger sizes of endotracheal tube can contribute to risk of stenosis (Hillel et al., 2016). Many individuals are initially asymptomatic or have only mild symptoms for weeks to months, as the stenosis insidiously progresses. Inspiratory stridor is the most common presenting symptom, however, dyspnoea, dry cough, dysphagia, although some patients present...

Acquired laryngeal and subglottic stenosis following COVID‐19—Preparing for the coming deluge