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Review
. 2022 Jan:73:103221.
doi: 10.1016/j.amsu.2021.103221. Epub 2022 Jan 3.

Pulmonary barotrauma in COVID-19: A systematic review and meta-analysis

Dhan Bahadur Shrestha  1 , Yub Raj Sedhai  2 , Pravash Budhathoki  3 , Ayush Adhikari  4 , Nisheem Pokharel  5 , Richa Dhakal  6 , Satyasuna Kafle  7 , Wasey Ali Yadullahi Mir  1 , Roshan Acharya  8 , Markos G Kashiouris  9 , Mark S Parker  10
Affiliations
Review

Pulmonary barotrauma in COVID-19: A systematic review and meta-analysis

Dhan Bahadur Shrestha et al. Ann Med Surg (Lond). 2022 Jan.

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.

Keywords: ARDS, Acute Respiratory Distress Syndrome; Barotrauma; COVID-19; COVID-19, Coronavirus Disease 2019; ICU, Intensive Care Unit; IMV, Invasive Mechanical Ventilation; NIPPV, Non-invasive Positive Pressure Ventilation; Pneumomediastinum; Pneumopericardium; Pneumothorax; SARS-Cov-2; Severe acute respiratory syndrome coronavirus-2; Subcutaneous emphysema.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Prisma flow diagram.
Fig. 2
Fig. 2
The proportion of barotrauma among observational studies, random effect model.
Fig. 3
Fig. 3
Common types of barotrauma reported, random effect model.
Fig. 4
Fig. 4
Laterality of pneumothorax in case studies.
See this image and copyright information in PMC

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