{"doi":"10.1111/jocn.15992","title":"Acquired laryngeal and subglottic stenosis following COVID‐19—Preparing for the coming deluge","abstract":"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 with wheezing or a history of recurrent bronchitis (Shinn et al., 2019). Tracheal stenosis is often misdiagnosed given similar presentations to asthma and other respiratory-related conditions. This possible confusion underscores the importance of obtaining a thorough medical history, including history of endotracheal intubation. The severity of tracheal stenosis is determined via laryngoscopy and can be staged based on the length, location and extent of obstruction (Figure 1). Staging has implication for both management and prognosis. The McCaffrey staging system classifies stenosis based on length and location of the stenosis (Table 1). In contrast, the Cotton-Meyer system of staging classifies stenosis severity based on the diameter of the remaining airway in correlation with the diameter of tracheal tubes, ranging from a Stage I classification for less than 70% obstruction to a Stage IV classification if there is 100% obstruction (Cotton, 1984; Myer et al., 1994) (Figure 2). The best studied approach to medical management of LTS is steroid injection. Protocols for serial steroid injections vary but most often involve multiple rounds of the synthetic glucocorticoid triamcinolone 40 mg/dl injected directly into the stenosis under direct visualisation, typically four injections spaced 3 to 6 weeks apart. These injections are usually performed while awake, using office-based laryngoscopy, and are very well-tolerated. This approach provides comparable improvements in peak expiratory flow compared to endoscopic dilation. Using steroidal injection as adjuvant therapy after dilation also can provide benefits, improving the inter-dilation interval compared to dilation alone. Whereas steroid injections have a more preventative and temporising role in the management of LTS, surgery is the mainstay of treatment for severe cases. The two main types of surgery are categorised as endoscopic (focused largely on dilation with or wi","journal":"Journal of Clinical Nursing","year":2021,"id":168729,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":30,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9511,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":698273,"name":"Jessica Peters","orcid":"0000-0002-7631-0596","position":1,"is_corresponding":false},{"id":548607,"name":"Andrew Benson","orcid":"0000-0001-5501-6008","position":2,"is_corresponding":false},{"id":698806,"name":"Carol S Maragos","orcid":null,"position":3,"is_corresponding":false},{"id":698274,"name":"Kimberly McIltrot","orcid":"0000-0002-8556-4803","position":4,"is_corresponding":false},{"id":698275,"name":"Tammy Slater","orcid":"0000-0002-5612-1050","position":5,"is_corresponding":false},{"id":698276,"name":"Lee M. Akst","orcid":"0000-0002-8925-0545","position":6,"is_corresponding":false},{"id":304743,"name":"Simon R. Best","orcid":"0000-0001-8699-033X","position":7,"is_corresponding":false},{"id":321791,"name":"Panagis Galiatsatos","orcid":null,"position":8,"is_corresponding":false},{"id":304741,"name":"Martin B. Brodsky","orcid":"0000-0002-3645-2944","position":9,"is_corresponding":false},{"id":304749,"name":"Michael Brenner","orcid":"0000-0003-4926-0957","position":10,"is_corresponding":false},{"id":304739,"name":"Vinciya Pandian","orcid":"0000-0002-2260-1080","position":11,"is_corresponding":false},{"id":698272,"name":"Sarah Allgood","orcid":"0000-0003-0259-6613","position":0,"is_corresponding":true}],"reference_count":6,"raw_metadata":null,"created_at":"2026-07-18T23:46:06.853307Z","pmid":"34369020","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}