Barotrauma in Coronavirus Disease 2019 Patients Undergoing Invasive Mechanical Ventilation: A Systematic Literature Review*

Abstract

There are concerns of a high barotrauma rate in coronavirus disease 2019 patients with acute respiratory distress syndrome receiving invasive mechanical ventilation. However, a few studies were published, and reported rates were highly variable. We performed a systematic literature review to identify rates of barotrauma, pneumothorax, and pneumomediastinum in coronavirus disease 2019 acute respiratory distress syndrome patients receiving invasive mechanical ventilation.DATA SOURCE: PubMed and Scopus were searched for studies reporting barotrauma event rate in adult coronavirus disease 2019 patients receiving invasive mechanical ventilation. STUDY SELECTION:We included all studies investigating adult patients with coronavirus disease 2019 acute respiratory distress syndrome requiring mechanical ventilation. Case reports, studies performed outside ICU setting, and pediatric studies were excluded. Two investigators independently screened and selected studies for inclusion. DATA EXTRACTION:Two investigators abstracted data on study characteristics, rate of pneumothorax, pneumomediastinum and overall barotrauma events, and mortality. When available, data from noncoronavirus disease 2019 acute respiratory distress syndrome patients were also collected. Pooled estimates for barotrauma, pneumothorax, and pneumomediastinum were calculated.DATA SYNTHESIS: A total of 13 studies with 1,814 invasively ventilated coronavirus disease 2019 patients and 493 noncoronavirus disease 2019 patients were included. A total of 266/1,814 patients (14.7%) had at least one barotrauma event (pooled estimates, 16.1% [95% CI,). Pneumothorax occurred in 132/1,435 patients (pooled estimates, 10.7%; 95% CI, 6.7-14.7%), whereas pneumomediastinum occurred in 162/1,432 patients (pooled estimates, 11.2%; 95% CI, 8.0-14.3%). Mortality in coronavirus disease 2019 patients who developed barotrauma was 111/198 patients (pooled estimates, 61.6%; 95% CI, 50.2-73.0%). In noncoronavirus disease 2019 acute respiratory distress syndrome patients, barotrauma occurred in 31/493 patients (6.3%; pooled estimates, 5.7%; 95% CI, −2.1% to 13.5%). CONCLUSIONS:Barotrauma occurs in one out of six coronavirus disease 2019 acute respiratory distress syndrome patients receiving invasive mechanical ventilation and is associated with a mortality rate of about 60%. Barotrauma rate may be higher than noncoronavirus disease 2019 controls.

Pneumothorax and barotrauma in invasively ventilated patients with COVID-19

“…Most of previously published studies reported no significant differences among mechanical ventilation settings/parameters between patients who developed barotrauma and those who did not. They also found a trend towards lower age and higher use of steroids in pneumothorax patients, which were also suggested by other Authors [2,16].…”

“…They found that pneumothorax rate among invasively ventilated COVID-19 patients is 80/594 (13 %), and mortality rate for patients who developed pneumothorax is 50/80 (62 %). On the contrary, among 160 randomly selected invasively ventilated COVID-19 patients without pneumothorax, mortality was 78/ 160 (49 %).We recently published a systematic review on rate of barotrauma among invasively ventilated COVID-19 patients [2]. Our pooled analysis included data from 13 studies and 1814 patients [3][4][5][6][7][8][9][10][11][12][13][14][15] and we found that pooled estimate of pneumothorax rate was 10.7 % (95 % confidence interval [CI] = 6.7 %-14.7 %), while overall rate of barotrauma event was 16.1 % (95 % CI = 11.8 %-20.4 %).…”

“…We recently published a systematic review on rate of barotrauma among invasively ventilated COVID-19 patients [2]. Our pooled analysis included data from 13 studies and 1814 patients [3][4][5][6][7][8][9][10][11][12][13][14][15] and we found that pooled estimate of pneumothorax rate was 10.7 % (95 % confidence interval [CI] = 6.7 %-14.7 %), while overall rate of barotrauma event was 16.1 % (95 % CI = 11.8 %-20.4 %).…”

“…Collectively, these data confirm that barotrauma occur frequently in COVID-19 patients requiring mechanical ventilation, and is associated with a worse outcome and a very high mortality risk. Interestingly, the study by Chopra et al is one of the few studies that identified worse lung mechanics at start of mechanical ventilation as a risk factor for development of barotrauma [2]. Most of previously published studies reported no significant differences among mechanical ventilation settings/parameters between patients who developed barotrauma and those who did not.…”

One-Year Multidisciplinary Follow-Up of Patients With COVID-19 Requiring Invasive Mechanical Ventilation

“…A possible explanation could lie in the previously proposed virus-induced lung frailty, which is thought to be a main contributor for the high incidence of barotrauma in COVID-19 patients. 67,68 In this prospective, the honeycombing CT pattern, when present, could represent a subpleural cluster of small pneumatoceles rather than cystic air spaces resulting from irreversible lobular disruption.…”