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Observational Study
. 2021 Jun;36(6):646-654.
doi: 10.1177/0885066621989959. Epub 2021 Mar 15.

High Incidence of Barotrauma in Patients With Severe Coronavirus Disease 2019

Michael R Kahn  1 , Richard L Watson  2 , Jay T Thetford  1 , Joseph Isaac Wong  1 , Nader Kamangar  3
Affiliations
Observational Study

High Incidence of Barotrauma in Patients With Severe Coronavirus Disease 2019

Michael R Kahn et al. J Intensive Care Med. 2021 Jun.

Abstract

Objective.: To report the high incidence of barotrauma in critically ill patients admitted to the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19) and to discuss its implications.

Design.: Retrospective cohort study.

Setting.: ICU of an academic county hospital in Los Angeles, CA admitted from March 15-June 20, 2020.

Patients.: 77 patients with COVID-19 pneumonia. 75 patients met inclusion criteria.

Results.: 21% of patients with severe COVID-19 sustained barotrauma (33% of patients receiving IMV, 8% of patients receiving (NIV). There were no differences between the barotrauma and non-barotrauma groups regarding demographics, illness severity, or medications received, nor tidal volume or average/peak airway pressures in those receiving IMV. In the barotrauma group there was a greater proportion of patients receiving therapeutic anticoagulation (81% vs. 47%, p = 0.023) and ventilated using airway pressure release ventilation mode (13% vs. 0%, p = 0.043). Barotrauma was associated with increased likelihood of receiving a tracheostomy (OR 2.58 [0.23-4.9], p = 0.018]), longer median ICU length of stay (17 days vs. 7 days, p = 0.03), and longer median length of hospitalization (26 days vs. 14 days, p < 0.001). There was also a trend toward prolonged median duration of IMV (12.5 days vs 7 days, p = 0.13) and higher average mortality (56% vs 37%, p = 0.25).

Conclusions.: Barotrauma is seen in 5-12% of patients with ARDS receiving IMV and is exceedingly rare in patients receiving NIV. We report a high incidence of barotrauma observed in critically ill patients with COVID-19 requiring either NIV or IMV. While there was a trend toward increased mortality in patients with barotrauma, this did not reach statistical significance. The increased incidence of barotrauma with COVID-19 may be a product of the pathophysiology of this disease state and a heightened inflammatory response causing rampant acute lung injury. Evidence-based medicine and lung-protective ventilation should remain the mainstay of treatment.

Keywords: COVID-19; adult; artificial; barotrauma; inflammation; physiology; respiration; respiratory distress syndrome.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Mortality in patients with and without barotrauma.
Figure 2.
Figure 2.
Incidence of barotrauma sustained in critically ill patients with COVID-19.
See this image and copyright information in PMC

References

    1. Kronbichler A, Kresse D, Yoon S, et al. Asymptomatic patients as a source of COVID-19 infections: a systematic review and meta-analysis. Int J Infect Dis. 2020;98(9):180–186. - PMC - PubMed
    1. Nishiura H, Kobayashi T, Miyama T, et al. Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19). Int J Infect Dis. 2020;94(5):154–155. - PMC - PubMed
    1. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069. - PMC - PubMed
    1. Papazian L, Forel JM, Gacouin A. et al. ACURASYS Study Investigators. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363(12):1107–1116. - PubMed
    1. Schnapp LM, Chin DP, Szaflarski N, Matthay MA. Frequency and importance of barotrauma in 100 patients with acute lung injury. Crit Care Med. 1995;23(2):272–278. - PubMed

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