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

Patrick Alexander Ward; Jonathan Marc Collier; Justin Weir; Michael Osborn; Brian Hanley; William James Buchanan Smellie; Chelwest COVID-19 Tracheostomy Group

doi:10.1111/coa.13872

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

Clin Otolaryngol. 2022 Jan;47(1):131-137. doi: 10.1111/coa.13872. Epub 2021 Oct 18.

Authors

Patrick Alexander Ward¹, Jonathan Marc Collier², Justin Weir³, Michael Osborn³, Brian Hanley³, William James Buchanan Smellie⁴; Chelwest COVID-19 Tracheostomy Group

Collaborators

Affiliations

¹ Magill Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.
² Department of Plastic and Reconstructive Surgery, Chelsea and Westminster Hospital, London, UK.
³ Department of Cellular Pathology, North West London Pathology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
⁴ Department of General Surgery, Chelsea and Westminster Hospital, London, UK.

Abstract

Objectives: This 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 participants: Retrospective 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: Group 1 demonstrated mild/moderate inflammation (tracheitis) in nearly all samples (15/16, 93.8%), with infrequent micro-ulceration (2/16, 12.5%). Group 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%).

Conclusions: Severe 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.

Keywords: COVID-19; histology; inflammation; mechanically ventilated; tracheal; ulceration.

MeSH terms

COVID-19 / epidemiology
COVID-19 / therapy*
Cross-Sectional Studies
Female
Humans
Intensive Care Units
London / epidemiology
Male
Middle Aged
Pneumonia, Viral / therapy*
Pneumonia, Viral / virology
Respiration, Artificial*
Retrospective Studies
SARS-CoV-2
Trachea / injuries*
Tracheostomy