Pulmonary barotrauma in mechanically ventilated coronavirus disease 2019 patients: A case series

Edwards, Jodi-Ann; Breitman, Igal; Bienstock, Jared; Badami, Abbasali; Kovatch, Irina; Dresner, Lisa

doi:10.1016/j.amsu.2020.11.054

Cited by 26 publications

(36 citation statements)

References 19 publications

(13 reference statements)

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“…Additional studies reported incidence of barotrauma in mechanically ventilated COVID-19 ARDS patients ranging from 10%-to-14%. 32 , 33 , 34 , 35 Contrary to the authors’ study, none of these present data on early predictors of PNX/PMD and data on mechanical ventilation settings were limited to the time of PNX/PMD development, 33 , 35 at the initial setting, 32 or absent. 34 Similarly to the authors’ study, PNX was managed with chest tube drainage in at least 50% of patients presented in available case series.…”

Section: Discussioncontrasting

confidence: 73%

“… 34 Similarly to the authors’ study, PNX was managed with chest tube drainage in at least 50% of patients presented in available case series. 33 , 35 Notably, in the study by Capaccione et al., the time from intubation to PNX onset was 14.9 days, similar to the authors’ study; 32 and in the study by Edwards et al., PNX or PMD occurred fewer than four days from start of mechanical ventilation. 33 …”

Section: Discussionsupporting

confidence: 61%

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Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients

Belletti

Palumbo

Zangrillo

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

106

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Objective To determine the incidence, predictors, and outcome of pneumothorax (PNX)/pneumomediastinum (PMD) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). Design Observational study. Setting Tertiary-care university hospital. Participants One hundred sixteen consecutive critically ill, invasively ventilated patients with COVID-19 ARDS. Interventions The authors collected demographic, mechanical ventilation, imaging, laboratory, and outcome data. Primary outcome was the incidence of PNX/PMD. Multiple logistic regression analyses were performed to identify predictors of PNX/PMD. Measurements and Main Results PNX/PMD occurred in a total of 28 patients (24.1%), with 22 patients developing PNX (19.0%) and 13 developing PMD (11.2%). Mean time to development of PNX/PMD was 14 ± 11 days from intubation. The authors found no significant difference in mechanical ventilation parameters between patients who developed PNX/PMD and those who did not. Mechanical ventilation parameters were within recommended limits for protective ventilation in both groups. Ninety-five percent of patients with PNX/PMD had the Macklin effect (linear collections of air contiguous to the bronchovascular sheaths) on a baseline computed tomography scan, and tended to have a higher lung involvement at intensive care unit (ICU) admission (Radiographic Assessment of Lung Edema score 32.2 ± 13.4 v 18.7 ± 9.8 in patients without PNX/PMD, p = 0.08). Time from symptom onset to intubation and time from total bilirubin on day two after ICU admission were the only independent predictors of PNX/PMD. Mortality was 60.7% in patients who developed PNX/PMD versus 38.6% in those who did not (p = 0.04). Conclusion PNX/PMD occurs frequently in COVID-19 patients with ARDS requiring mechanical ventilation, and is associated with increased mortality. Development of PNX/PMD seems to occur despite use of protective mechanical ventilation and has a radiologic predictor sign.

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Section: Discussioncontrasting

confidence: 73%

Section: Discussionsupporting

confidence: 61%

Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients

Belletti

Palumbo

Zangrillo

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

106

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“…On the other hand, multiple case series studies reported a 10--14% incidence of PBT in mechanically ventilated ARDS patients infected with COVID-19. 11,[14][15][16] In our study, the incidence of PBT was higher in patients who received NIPPV than IPPV (34/127,26.8% vs 17/112,15.2%, respectively, p= 0.043). More patients from PBT group received NIPPV than IPPV (66.7% and 33.3%, respectively), compared to the NPBT group (50.5% and 49.5%, respectively).…”

Section: Discussionmentioning

confidence: 43%

“…This finding is similar to the study by Edwards et al in which PNX/PMD occurred in less than four days from the start of mechanical ventilation. 16 Multiple studies indicated that PNX usually develops at a relatively late stage (3–8 weeks) after the onset of symptoms. 45 , 46 In a study by Capaccione et al, the time from intubation to PNX event was 14.9 days which is similar to that described by Belletti et al, in which the time from intubation to PNX was 14 days.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Barotrauma in COVID-19 Patients: Invasive versus Noninvasive Positive Pressure Ventilation

Hamouri¹,

Samrah²,

Albawaih³

et al. 2021

IJGM

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This study aims to determine the incidence and outcome of COVID-19 patients who required positive pressure ventilation (PPV) and subsequently developed pulmonary barotrauma (PBT). Also, to investigate the risk factors and predictors of these complications to better understand the disease pathogenesis. Patients and Methods: This retrospective analysis enrolled all adult COVID-19 patients admitted through the period from October 1, 2020, to December 31, 2020. All patients who received any form of PPV were included. Patients were then divided into two groups based on PBT development, including subcutaneous emphysema, pneumothorax, and pneumomediastinum. Medical records of all patients were reviewed. Patients' demographics, laboratory data on admission, respiratory support modes, surgical interventions, and outcomes were collected and analyzed. Results: In the specified period, 1095 patients were hospitalized due to COVID-19 illness. A total of 239 (21.8%) of all admitted patients received PPV. PBT accounted for 21.3% (51/ 239) of the study cohort. While both groups were equally exposed to the same modes of PPV, receiving invasive ventilation significantly correlated with decreased PBT odds (OR = 0.891; 95% CI, 0.803-0.988; p=0.029). PBT patients were significantly younger (p<0.001). Diabetes mellitus was found to have a protective effect on developing PBT (OR = 0.867; 95% CI, 0.782-0.962), while PO 2 /FIO 2 ratio was inversely associated with higher odds of developing PBT in both univariate and multivariate analyses (p=0.03 and p=0.019, respectively). Conclusion: COVID-19-infected patients are at a higher risk of developing PBT. Invasive positive pressure ventilation was associated with less PBT compared to noninvasive ventilation and delaying intubation does not seem to reduce the risk of pulmonary barotrauma.

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“…Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is responsible for over 86 million cases and 1.8 million deaths worldwide. According to Edwards et al, 26% of those infected with the virus progress to acute respiratory distress syndrome (ARDS) requiring endotracheal tube placement and mechanical ventilation [1]. Pulmonary barotrauma is a potential complication of invasive mechanical ventilation and is a poor predictor of morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Barotrauma Linked to Coronavirus Disease 2019 Infection in Younger Patients: A Case Series

Ng¹,

Degaetano²,

Trivedi³

et al. 2021

Cureus

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Patients infected with coronavirus disease 2019 (COVID-19) on invasive mechanical ventilation were found to have high rates of barotrauma. Herein, we present five patients admitted to the intensive care unit between March and April 2020, who developed barotrauma as a complication of COVID-19 pneumonia. This series includes four males and one female with a mean age of 54 years, most without significant chronic comorbidities or former tobacco use. All were intubated for hypoxic respiratory failure due to the COVID-19 infection. The diagnosis of barotrauma was confirmed via radiography showing the presence of pneumothorax, pneumomediastinum, or subcutaneous emphysema on radiographic imaging. At the time, they were evaluated for convalescent plasma infusion, remdesivir, and interleukin-6 inhibitor. Each of the five patient's hospital courses were documented. The average number of days between intubation and subsequent barotrauma was 6.8 days with the mean length of hospital stay being 49 days. Three of the five patients passed away due to complications related to COVID-19. Due to the unknown nature of the virus, our findings add to the growing evidence that those infected, even without significant comorbidities, are at high risk for pulmonary complications and in-hospital mortality.

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Pulmonary barotrauma in mechanically ventilated coronavirus disease 2019 patients: A case series

Cited by 26 publications

References 19 publications

Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients

Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients

Pulmonary Barotrauma in COVID-19 Patients: Invasive versus Noninvasive Positive Pressure Ventilation

Barotrauma Linked to Coronavirus Disease 2019 Infection in Younger Patients: A Case Series

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