Extensive tracheal injuries: a reasoned multi-step approach to guarantee mechanical ventilatory support developed during COVID-19 pandemic.

COVID-19 pandemic has notably increased the need for prolonged mechanical ventilation (MV) in patients with respiratory failure. This has increased the risk of extensive tracheal injuries (ETI) associated with life-threatening complications in very complex patients. Furthermore, tracheal injury treatment in COVID-19 patients has not been described yet. Three COVID-19 patients with ETI who required MV treated between April and November 2020 were included. A multi-step approach was performed in order to restore tracheal integrity with a custom remodeled stent and tracheostomy tube placement to allow ventilatory support. Efficient MV with no residual air leaks was obtained in all cases. One patient died six weeks after the procedure due to COVID-19 lung damage. Two patients have completely been weaned from MV. This multi-step procedure could be used in order to maintain ventilatory support in case of ETI, working as a bridge to subsequent surgery when clinical conditions improve.