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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">COVID-19 is an infection caused by the SARS-CoV-2 virus that can cause severe or fatal complications in high-risk patients&#46; Though rare&#44; we have observed several cases of necrotizing tracheobronchitis&#44; which causes airway obstruction&#44; with necrotic and hemorrhagic debris that obstruct the trachea and bronchi&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">This problem has already been described in infections caused by the H1N1 flu virus&#44; bacterial infections&#44; and diseases such as rheumatoid arthritis or ulcerative colitis&#46; It is associated with the formation of bronchial blood clots&#44; bronchial hypersecretion&#44; and presence of bacterial lung infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;2</span></a> Said clots provoke severe obstruction of the bronchial lumen&#44; leading to an increase in airway pressure and making ventilation impossible&#46; In many cases&#44; it is necessary to exchange the endotracheal tube urgently&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This complication&#44; which we believe may influence a patient&#39;s prognosis&#44; entails an increase in risk of contagion by healthcare personnel&#59; it is one of the procedures classified as of greatest risk for viral transmission from patients to healthcare personnel&#44; along with bronchoscopy&#44; aerosol therapy&#44; nebulization&#44; and aspiration of secretions&#46; The aim of our study is to analyze the prognosis of patients with COVID-19 who have undergone an episode of endotracheal tube obstruction that made exchanging it necessary&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">During the period from February to April 2020&#44; 26 patients were hospitalized in our ICU&#58; 22 &#40;84&#46;7&#37;&#41; required invasive mechanical ventilation &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Of those&#44; 16 &#40;72&#46;7&#37;&#41; presented with at least one episode of endotracheal tube obstruction that required an exchange&#46; What&#39;s more&#44; none of these incidents occurred before the seventh day mechanical ventilation&#44; with a mean day of onset of 10&#46;5 days&#46; Some patients even required a tube exchange on more than one occasion&#46; The mean number of exchanges was 1&#46;46&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">If we compare patients who had endotracheal tube obstruction and tube exchange &#40;which we will group together in the first group&#41; with those who did not need it &#40;the second group&#41;&#44; we can observe that there are significant differences in the days they required mechanical ventilation &#40;21&#46;6 vs&#46; 17&#46;5 days&#41;&#46; Therefore&#44; a greater number of patients in the first group required a tracheotomy before proceeding to be weaned off of mechanical ventilation &#40;81&#46;2&#37; vs&#46; 18&#46;7&#37;&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Eleven patients developed respiratory superinfection as a complication during hospitalization&#44; eight of which &#40;72&#46;7&#37;&#41; were among those who presented with endotracheal tube obstruction&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In regard to treatment received&#44; it should be noted that 100&#37; of patients who did not present with obstruction received treatment with azithromycin&#44; in contrast to the first group&#44; in which only 56&#46;2&#37; did&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Lastly&#44; five patients died&#58; Three &#40;60&#37;&#41; in the first group&#44; a greater proportion than in the second group&#44; which did not have obstruction&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Our experience with patients diagnosed with pneumonia due to COVID-19 is that they present with an elevated frequency of necrotizing tracheobronchitis after the first week of mechanical ventilation&#44; causing a sudden obstruction of the endotracheal tube that requires its immediate exchange due to hypoxemia and the inability to ventilate the patients&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In this disease&#44; an increase in the immune response is described&#44; with a generalized migration of proinflammatory cytokines and an increase in fibrin deposits observed in the pulmonary area due to deregulation between the coagulation and fibrinolytic systems&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> This entails a problem that can affect biosecurity when it comes to management by healthcare personnel&#44; as it requires immediate intervention&#46; In other infections&#44; upon histopathological examination of the trachea and bronchial samples&#44; mononuclear cell infiltration has been seen in the mucosa and submucosa with desquamation of the bronchial epithelium accompanied by congestion&#44; hemorrhage&#44; and necrosis in the tracheobronchial area&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">It is necessary to study the protective association of the use of azithromycin in this problem associated with COVID-19&#8212;a drug has also been used in other clinical entities&#8212;due to its anti-inflammatory and immunomodulating effect&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6&#44;7</span></a></p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duration of mechanical ventilation &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tracheotomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;72&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;81&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;18&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean number of days on which endotracheal tube obstruction occurred&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;5 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean number of occasions in which endotracheal tube exchange was required&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;5 times&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Development of respiratory superinfections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;72&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;17&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Use of azithromycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;68&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stay in the ICU &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;22&#46;72&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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November 2020 Necrotizing tracheobronchitis with endotracheal tube obstruction in COVID-19 patients
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Vol. 220. Issue 8.
Pages 531-533 (November 2020)
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Vol. 220. Issue 8.
Pages 531-533 (November 2020)
Correspondence
DOI: 10.1016/j.rceng.2020.05.002
Necrotizing tracheobronchitis with endotracheal tube obstruction in COVID-19 patients
Traqueobronquitis necrosante con obstrucción del tubo endotraqueal en pacientes COVID-19
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G. Pérez Acosta, L. Santana-Cabrera
Corresponding author
lsancabx@gobiernodecanarias.org

Corresponding author.
Servicio de Medicina Intensiva, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Las Palmas, Spain
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Table 1. Differences between patients with COVID-19 according to whether they presented with endotracheal tube obstruction due to necrotizing tracheobronchitis.

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