Oropharyngeal hemorrhage in patients with COVID-19: A multi-institutional case series

Patients with COVID-19 who are intubated and require mechanical ventilation have been observed to have oropharyngeal bleeding necessitating otolaryngology intervention. We report five cases of oropharyngeal hemorrhage in COVID-19 patients on mechanical ventilation requiring evaluation by otolaryngol...

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Bibliographic Details
Published in:American journal of otolaryngology 2020-11, Vol.41 (6), p.102691-102691, Article 102691
Main Authors: Mulcahy, Collin F., Ghulam-Smith, Melissa, Mamidi, Ishwarya S., Thakkar, Punam G., Edwards, Heather, Tummala, Neelima, Tracy, Lauren F.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Antibiotics
Anticoagulants
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
Betacoronavirus
Bleeding
Blood platelets
Coronavirus Infections - complications
Coronaviruses
COVID-19
Disease transmission
ECMO
Extracorporeal Membrane Oxygenation
Female
Gauze
Health care facilities
Hemoglobin
Hemorrhage
Hemorrhage - etiology
Hemorrhage - therapy
Humans
Informed consent
Intervention
Intubation
Intubation, Intratracheal
Male
Mechanical ventilation
Medical equipment
Middle Aged
Oropharyngeal hemorrhage
Otolaryngology
Oxygenation
Pandemics
Patients
Pharyngeal Diseases - etiology
Pharyngeal Diseases - therapy
Pneumonia, Viral - complications
Pressure ulcers
Respiration, Artificial
Respiratory Distress Syndrome - therapy
Respiratory Distress Syndrome - virology
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Tampons, Surgical
Tubes
Ventilation
Ventilators
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Summary:Patients with COVID-19 who are intubated and require mechanical ventilation have been observed to have oropharyngeal bleeding necessitating otolaryngology intervention. We report five cases of oropharyngeal hemorrhage in COVID-19 patients on mechanical ventilation requiring evaluation by otolaryngologists at George Washington University Hospital (GWUH) and Boston Medical Center (BMC) from March to April 2020. Institutional Review Board at both institutions exempted this study from informed consent because there were no identifiable patient characteristics, photographs, or imaging studies included. All five patients were managed conservatively; four required packing with Kerlix gauze by an otolaryngologist. Two patients had the additional requirement of extracorporeal membrane oxygenation (ECMO) and associated anticoagulation. Three patients improved with oropharyngeal packing; two had persistent bleeding. Three patients expired. Endotracheal tubes were repositioned less frequently due to the COVID-19 pandemic. Intubated patients with COVID-19 may have an increased risk of oropharyngeal hemorrhage. This may be due to anticoagulation, prolonged intubation, or decreased frequency of endotracheal tube repositioning. Otolaryngologists should wear appropriate PPE when managing this hemorrhagic complication.
ISSN:0196-0709
1532-818X
DOI:10.1016/j.amjoto.2020.102691