Covid-19 Pneumonia and Ventilation-induced Lung Injury: A Case Report

Abstract

We present the case of a 67-year-old male patient, who was admitted to the intensive care unit for hypoxemic respiratory failure due to severe COVID-19 pneumonitis, requiring mechanical ventilation. Despite close monitoring using transpulmonary pressure measurements and interventions to pursue lung-protective ventilation, the patient developed extensive barotrauma including a right-sided pneumothorax, subcutaneous emphysema and pneumomediastinum while on pressure support ventilation. We hypothesize that the high respiratory drive that COVID-19 patients seem to exhibit, combined with diffuse alveolar injury and increased alveolar pressure, resulted in gross barotrauma.

Conclusion: The respiratory characteristics that COVID-19 patients seem to exhibit might expose those on mechanical ventilation to an increased risk of developing ventilation-induced lung injury. This case emphasizes that caution should be taken in the respiratory treatment of patients with COVID-19 pneumonitis.

Keywords: COVID-19 pneumonia; ICU; barotrauma; mechanical ventilation; pneumomediastinum.

Figure 1

Transpulmonary pressure measurement during short inspiratory occlusion

Figure 2

Chest CT showing (A) a right-sided apical pneumothorax and subcutaneous emphysema up to the left side of the neck and (B) extensive pneumomediastinum * Paw: airway pressure (cmH₂O), Pes: esophageal pressure (cmH₂O), PL: transpulmonary pressure (cmH₂O)