Pulmonary barotrauma in COVID-19: A systematic review and meta-analysis. (January 2022)

• Record Type: Journal Article
• Authors: Shrestha, Dhan Bahadur; Sedhai, Yub Raj; Budhathoki, Pravash; Adhikari, Ayush; Pokharel, Nisheem; Dhakal, Richa; Kafle, Satyasuna; Yadullahi Mir, Wasey Ali; Acharya, Roshan; Kashiouris, Markos G.; Parker, Mark S.
• Is Part Of: Annals of medicine and surgery. Volume 73(2022)
• Publication Date: 2022-01
• Subjects: COVID-19 Coronavirus Disease 2019 -- IMV Invasive Mechanical Ventilation -- ARDS Acute Respiratory Distress Syndrome -- NIPPV Non-invasive Positive Pressure Ventilation -- ICU Intensive Care Unit; COVID-19 -- Barotrauma -- Pneumothorax -- Pneumomediastinum -- Pneumopericardium -- Subcutaneous emphysema -- Severe acute respiratory syndrome coronavirus-2 -- SARS-Cov-2; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2021.103221
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Background: An ever-increasing number of studies have reported an increased incidence of spontaneous pulmonary barotrauma such as pneumothorax, pneumomediastinum, and subcutaneous emphysema in patients with COVID-19. We conducted this systematic review and meta-analysis to assess the value and significance of the available data. Methods: A thorough systematic search was conducted to identify studies of barotrauma in hospitalized patients with COVID-19. Data analysis of case reports was done using a statistical package for the social sciences (SPSS) version 22, and meta-analysis was performed using CMA-3. Results: We identified a total of 4488 studies after thorough database searching.118 case reports and series, and 15 observational studies were included in the qualitative analysis. Fifteen studies were included in the quantitative analysis. The observational studies reported barotrauma in 4.2% (2.4–7.3%) among hospitalized patients; 15.6% (11–21.8%) among critically ill patients; and 18.4% (13–25.3%) in patients receiving invasive mechanical ventilation, showing a linear relationship of barotrauma with the severity of the disease. In addition, barotrauma was associated with a longer length of hospital stay, more extended ICU stay, and higher in-hospital mortality. Also, a slightly higher odds of barotrauma was seen in COVID-19 ARDS compared with non-COVID-19 ARDS. Conclusion: COVID-19 pneumonia is associated with a higher incidence of barotrauma. It presents unique challenges for invasive and non-invasive ventilation management. Further studies are required to unravel the underlying pathophysiology and develop safer management strategies. Highlights: Barotrauma was reported among 4.2% (2.4–7.3) of patients hospitalized with COVID-19. Among critically ill patients with COVID-19, barotrauma was reported in 15.6% (11–21.8). A higher incidence of barotrauma was reported among patients who received mechanical ventilation [18.4%, (13–25.3)].