Disclosures: Merna Naji, MD: No financial relationships or conflicts of interest

Case Diagnosis: 51-year-old male with a history of COVID-19 infection and tracheostomy found to have severe tracheal stenosis.

Case Description: We report a previously healthy 51-year-old male with a complicated recovery course following infection with COVID-19. His acute hospitalization necessitated prolonged intubation, veno-venous ECMO support, and tracheostomy placement. Upon admission to inpatient rehabilitation (IPR), the patient demonstrated repeated poor tolerance to Passy-Muir Valve (PMV) with significant respiratory distress within seconds of valve placement. The otolaryngology service performed a flexible laryngoscopy and noted no significant abnormalities. Additional consulting teams recommended further evaluation into patient anxiety as an etiology. Despite the above, the patient continued to be intolerant to PMV and capping trials. This prompted a thorough second laryngoscopy under sedation, and the patient was found to have near-complete subglottic stenosis. The patient’s IPR goals changed drastically to a prehabilitation program based on potential impending surgical interventions subsequent to stenosis findings. The patient eventually underwent successful tracheal serial dilatations and T-tube placement after IPR discharge.

Setting: IPRAssessment/

Results: 51-year-old male with a history of COVID-19 infection and tracheostomy found to have severe tracheal stenosis in IPR which resulted in a shift of goals to prehabilitation.

Discussion: The diagnosis of tracheal stenosis is important to consider in patients with a prolonged course of intubation who have undergone tracheostomy and are intolerant of PMV and capping trials. The complication rate of stenosis in COVID-19 patients who underwent tracheostomy is still unknown, however physiatrists and speech therapists play a vital role in detecting stagnation of expected patient progress.

Conclusion: Tracheal stenosis is a known complication of tracheostomy, and the effect of COVID-19 infection on incidence is yet to be elucidated. Signs and symptoms of stenosis should be thoroughly and continuously investigated in the context of non-progressing speaking valve and capping trials during the initial rehabilitation evaluation and also while in the IPR setting.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-unusual-case-of-tracheal-stenosis-in-a-covid-19-patient-on-the-inpatient-rehabilitation-unit/