Histological findings of tracheal samples from COVID‐19 positive critically ill mechanically ventilated patients

• DOI: 10.1111/coa.13872
• Publication Date: 2021-10-05T22:29:44Z
• Authors: Patrick Alexander...; Jonathan Marc Col...; Justin Weir; Michael Osborn; Brian Hanley; William James Buc...
• Keywords: Male; SARS-CoV-2; Pneumonia, Viral; COVID-19; Middle Aged; Respiration, Artificial; 3. Good health; Trachea; Intensive Care Units; 03 medical and health sciences; Cross-Sectional Studies; Tracheostomy; 0302 clinical medicine; London; Humans; Female; Retrospective Studies

AbstractObjectivesThis study examines the histological findings of tracheal tissue samples obtained from COVID‐19 positive mechanically ventilated patients, to assess the degree of tracheal inflammation/ulceration present.Design and participantsRetrospective single‐centre observational cohort study. All patients admitted to Adult Intensive Care Unit (AICU) with COVID‐19 infection, requiring mechanical ventilation and surgical tracheostomy between 1 April and 1 May 2020, were included (Group 1). Tracheal windows excised at tracheostomy underwent histological analysis. Comparison was made with: tracheal windows from COVID‐19 positive AICU ventilated patients admitted between 1 January and 1 March 2021 (Group 2); tracheal windows from COVID‐19 negative AICU ventilated patients (Group 3); and, tracheal autopsy samples from COVID‐19 positive patients that died without undergoing prolonged mechanical ventilation (Group 4).Results G roup 1 demonstrated mild/moderate inflammation (tracheitis) in nearly all samples (15/16, 93.8%), with infrequent micro‐ulceration (2/16, 12.5%). G roup 2 demonstrated similar mild/moderate inflammation in all samples (17/17, 100%), with no ulceration. Histological findings of Groups 1 and 2 COVID‐19 positive patients were similar to Group 3 COVID‐19 negative patients, which demonstrated mild/moderate inflammation (5/5, 100%), with uncommon superficial erosion (1/5, 20%). Group 4 demonstrated mild chronic inflammation or no significant inflammation, with uncommon micro‐ulceration (1/4, 25%).ConclusionsSevere tracheal inflammation was not demonstrated in mechanically ventilated COVID‐19 positive patients at the level of the second/third tracheal rings, at the stage of disease patients underwent tracheostomy. Histological findings were similar between mechanically ventilated COVID‐19 positive and negative patients. Tracheal ulceration may be a feature of early or severe COVID‐19 disease.