Bilateral Vocal Cord Paralysis Due to Prolonged Intubation in COVID-19 Patients-Case Reports

Patients typically undergo tracheostomy tube placement after prolonged intubation in order to decrease the risks of endotracheal intubation including laryngeal stenosis, swelling and vocal cord paralysis. This is done prior to 21 days of intubation. During the current coronavirus pandemic there has been an increase in endotracheal intubations and delay in tracheostomy tube placement beyond the 21 days secondary to new recommendations. Presented here are two cases at our institution of patients with the novel coronavirus disease (COVID-19) and prolonged (>21 days) intubation prior to tracheostomy tube placement that have bilateral vocal cord paralysis without laryngeal or tracheal stenosis after extubation. Although the new recommendations of delayed tracheostomy tube placement are intended to decrease spread, there may be increased incidence of unintended effects to the patients.