Pulmonary Barotrauma in COVID-19 Patients With ARDS on Invasive and Non-Invasive Positive Pressure Ventilation. (September 2021)

• Record Type: Journal Article
• Authors: Rajdev, Kartikeya; Spanel, Alan J.; McMillan, Sean; Lahan, Shubham; Boer, Brian; Birge, Justin; Thi, Meilinh
• Is Part Of: Journal of intensive care medicine. Volume 36:Number 9(2021)
• Page Start: 1013
• Page End: 1017
• Publication Date: 2021-09
• Subjects: COVID-19 -- pulmonary barotrauma -- mechanical ventilation -- acute respiratory distress syndrome -- pneumothorax -- pneumomediastinum; Critical care medicine -- Periodicals; Critical Care -- Periodicals; Soins intensifs -- Périodiques; Soins intensifs; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.02805
• DOI: 10.1177/08850666211019719
• Languages: English
• ISSNs: 0885-0666

Abstract

Background: We experienced a high incidence of pulmonary barotrauma among patients with coronavirus disease-2019 (COVID-19) associated acute respiratory distress syndrome (ARDS) at our institution. In current study, we sought to evaluate the incidence, clinical outcomes, and characteristics of barotrauma among COVID-19 patients receiving invasive and non-invasive positive pressure ventilation. Methodology: This retrospective cohort study included adult patients diagnosed with COVID-19 pneumonia and requiring oxygen support or positive airway pressure for ARDS who presented to our tertiary-care center from March through November, 2020. Results: A total of 353 patients met our inclusion criteria, of which 232 patients who required heated high-flow nasal cannula, continuous or bilevel positive airway pressure were assigned to non-invasive group. The remaining 121 patients required invasive mechanical ventilation and were assigned to invasive group. Of the total 353 patients, 32 patients (65.6% males) with a mean age of 63 ± 11 years developed barotrauma in the form of subcutaneous emphysema, pneumothorax, or pneumomediastinum. The incidence of barotrauma was 4.74% (11/232) and 17.35% (21/121) in the non-invasive group and invasive group, respectively. The median length of hospital stay was 22 (15.7 −33.0) days with an overall mortality of 62.5% (n = 20). Conclusions: Patients with COVID-19 ARDS have a high incidence of barotrauma. Pulmonary barotrauma should be considered in patients with COVID-19 pneumonia who exhibit worsening of their respiratory disease as it is likely associated with a high mortality risk. Utilizing lung-protective ventilation strategies may reduce the risk of barotrauma.