Background Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may result in hypoxic respiratory failure necessitating mechanical ventilation. Barotrauma is a well-documented complication of mechanical ventilation. Objective To describe the presentation, characteristics, and management of mechanically ventilated patients with COVID-19 who developed barotrauma. Methods Retrospective case series study of 13 adult, mechanically ventilated, laboratory-confirmed COVID-19 positive patients admitted between 3/15/2020 and 4/14/2020 to a community hospital in New York City. Patient demographics, clinical course, ventilatory parameters, and radiographic results were obtained from electronic medical records. Barotrauma was defined as pneumomediastinum, subcutaneous emphysema, and or pneumothorax on chest X-ray. Descriptive analyses and Mann-Whitney U test were performed, where appropriate. Results Of the 574 COVID-19 positive patients, 139 (24.2%) needed mechanical ventilation and 13 (9.4%) of those developed barotrauma. Majority of patients were Black race (92.3%), older than age 65 (56.8%), male (69.2%), and had comorbidities (76.9%). Most common presenting symptoms were cough (84.6%) and dyspnea (76.9%). Barotrauma presentations included 3/13 pneumothoraces and pneumomediastinum, 12/13 pneumomediastinum and subcutaneous emphysema, and 1/13 pneumothorax alone. The average days on ventilator was 3.4, average positive expiratory-end pressure 15.5 cmH2O, dynamic compliance 33.8 mL/cmH2O, and P/F ratio 165. Interventions were 4/13 chest tubes and 2/13 pigtail catheters. Conclusions Barotrauma is a common complication of mechanical ventilation of COVID-19 patients. Despite high ventilatory pressures, tension pneumothorax is rare and barotrauma could potentially be managed conservatively. Further studies are needed to evaluate the indication and outcome of thoracostomies and conservative management.

During early 2020, New York City became an epicenter for coronavirus disease 2019. The University Hospital of Brooklyn, which is the primary teaching hospital for the State University of New York Downstate Health Sciences University, became the only COVID-19 designated hospital in Brooklyn. The Department of Surgery implemented drastic changes to address the hospital’s needs while remaining committed to the education of surgical residents. They ensured resident safety, continued surgical education, participation and contribution to the care of COVID-19 patients. We were able to accomplish these goals using an access and procedure team and program-wide use of video-conferencing platforms. Here, we have shared our experiences and solutions to the challenges that our department faced during this pandemic.

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