Pulmonary Barotrauma in COVID-19 Patients With ARDS on Invasive and Non-Invasive Positive Pressure Ventilation

Kartikeya Rajdev, Alan J Spanel, Sean McMillan, Shubham Lahan, Brian Boer, Justin Birge, Meilinh Thi
Journal of Intensive Care Medicine 2021 May 20, : 8850666211019719

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 estimate the incidence, clinical outcomes, and characteristics of barotrauma among COVID-19 patients receiving invasive and non-invasive positive pressure ventilation.

METHODOLOGY: We conducted this retrospective cohort study of 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 232patients 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 353 patients, 32 patients (65.6% males) with a mean age of 63 ± 11 years developed barotrauma in the form of either subcutaneous emphysema, pneumothorax, or pneumomediastinum. The incidence of barotrauma was 4.74% (11/232) and 17.35% (21/121) in 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 rate 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.

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