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

Shrestha, Dhan Bahadur; Sedhai, Yub Raj; Budhathoki, Pravash; Adhikari, Ayush; Pokharel, Nisheem; Dhakal, Richa; Kafle, Satyasuna; Mir, Wasey Ali Yadullahi; Acharya, Rajesh; Kashiouris, Markos; Parker, Mark S.

doi:10.1016/j.amsu.2021.103221

Cited by 39 publications

(75 citation statements)

References 31 publications

(62 reference statements)

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“…On analysis, the authors concluded that the incidence of barotrauma was 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 on invasive mechanical ventilation. This demonstrated a linear relationship of barotrauma with the severity of the underlying disease [38].…”

Section: Discussionmentioning

confidence: 82%

Pulmonary Barotrauma in COVID-19 Patients: Experience From a Secondary Care Hospital in Oman

Kajenthiran¹,

Tiwary²,

Lal³

et al. 2022

Cureus

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BackgroundDuring the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), many patients developed pulmonary barotrauma either self-inflicted or ventilator-induced. In pulmonary barotrauma, air leaks into extra-alveolar tissue resulting in pneumomediastinum, subcutaneous emphysema, pneumothorax, and pneumoperitoneum. MethodsAfter obtaining institutional approval, we retrospectively reviewed data from March 1, 2021, to September 31, 2021. Being a retrospective study, informed consent was not applicable. Patient data were collected from the Al Shifa patient information portal, which is an electronic medical record system available to all hospitals in the Ministry of Health, Oman. After identifying patients with pulmonary barotrauma, the following details were recorded and entered into an Excel sheet (Microsoft Corporation, Albuquerque, New Mexico) and a database was created, which contained the following: age, sex, smoking history, comorbidities, type, location, mode of barotrauma, mode of ventilation, length of intensive care unit (ICU) stay, interventions performed, and overall outcome (survived/deceased). ResultsA total of 529 patients with COVID-19 pneumonia were admitted from March 2021 to September 2021 to the ICU. Twenty-eight patients developed barotrauma of variable severity and required interventions like the placement of intercostal drains. Out of 28, five patients developed spontaneous barotrauma, 14 patients had barotrauma after initiation of non-invasive ventilation, and nine patients had barotrauma as a result of invasive ventilation. The median number of days in the ICU was 19.5 (interquartile range: 12.5-26.5). Of the 28 patients, eight patients survived and were discharged from the hospital. ConclusionIn this single-center, retrospective study at a secondary care hospital in Oman, we described our experience with patients who suffered pulmonary barotrauma during their ICU admission. We have also presented the incidence of spontaneous versus ventilator-induced barotrauma, the length of stay of these patients, the outcomes in terms of survival or death, the need for tracheostomy, secondary infections, and interventions performed as indicated.

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Section: Discussionmentioning

confidence: 82%

Pulmonary Barotrauma in COVID-19 Patients: Experience From a Secondary Care Hospital in Oman

Kajenthiran¹,

Tiwary²,

Lal³

et al. 2022

Cureus

View full text Add to dashboard Cite

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“…Although there are several studies regarding the pneumothorax of COVID-19 patients [11,[15][16][17], to the best of our knowledge, studies describing the impact of the pandemic on non-COVID-19-related pneumothorax patients are lacking. We tried to fill this gap and evaluated the impact of the pandemic on non-COVID-related pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

The Collateral Damage of the Pandemic on Non-COVID Related Pneumothorax Patients: A Retrospective Cohort Study

Woo

Kim

et al. 2022

JCM

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Background: Since the onset of the COVID-19 pandemic, there have been many reported cases showing the consequences—or the collateral damages—of COVID-19 on patients with non-COVID-related diseases. This study aimed to compare the clinical manifestations and treatment results of non-COVID-related pneumothorax patients before and during the pandemic. Methods: We retrospectively reviewed non-COVID-related pneumothorax patients who visited our hospital before the onset of the pandemic and during the pandemic. The primary outcome was the difference in the amount of pneumothorax between the two periods, and the secondary outcome was the difference in the treatment results between them. Multivariable logistic regression was conducted to find risk factors related to massive pneumothorax. Results: There were 122 and 88 patients in the pre-pandemic and pandemic groups, respectively. There was no significant difference between the two groups with respect to the preoperative demographic variables. However, the median amount of pneumothorax was significantly higher in the pandemic group (pre-pandemic: 34.75% [interquartile range (IQR) 18.30–62.95] vs. pandemic: 53.55% [IQR 33.58–88.80], p < 0.0001) and massive pneumothorax were more frequent in the pandemic group (52.3% vs. 30.3%, p = 0.002). Furthermore, more patients experienced re-expansion pulmonary edema after treatments during the pandemic (p = 0.0366). In multivariable analysis, the pandemic (OR: 2.70 [95% CI 1.49–4.90], p = 0.0011) was related to the occurrence of massive pneumothorax. Conclusion: During the pandemic, patients presented with a larger size of pneumothorax and had more re-expansion pulmonary edema, even in a country that handled the COVID-19 pandemic relatively well.

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“…One of the most common myths regarding APRV is that it causes barotrauma ( Myers and Macintyre, 2007 ; Dries and Marini, 2009 ; Esan et al, 2010 ; Kallet 2011 ; Daoud et al, 2012 ; Mireles-Cabodevila and Kcmarek, 2016 ; Hirshberg et al, 2018 ; Kami et al, 2019 ), yet is not supported by scientific literature. We are not saying barotrauma does not occur with APRV, but we are saying it does not happen more frequently than in any other ventilatory condition–including in patients receiving non-invasive ventilation or high flow nasal cannula ( Hamouri et al, 2021 ; Palumbo et al, 2021 ; Shrestha et al, 2022 ). In fact, there is no evidence demonstrating any component (alone or in combination) is the sole cause of barotrauma.…”

Section: Myth #2—airway Pressure Release Ventilation Causes Barotraumamentioning

confidence: 92%

“…The potential for barotrauma seems primarily associated with the severity of underlying (acute or chronic) lung disease, which may be aggravated by mechanical ventilation ( Anzueto et al, 2004 ). More recently, barotrauma rates have been reported to occur with greater frequency in COVID related ARDS (CARDS) but not specific to any one ventilator mode ( McGuinness et al, 2020 ; Gazivoda et al, 2021 ; Hamouri et al, 2021 ; Rajdev et al, 2021 ; Udi et al, 2021 ; Belletti et al, 2022 ; Shrestha et al, 2022 ). In a systematic review and meta-analysis, a linear association of increased barotrauma incidence with increasing disease severity was observed in COVID-19 patients requiring various forms of invasive and non-invasive respiratory support ( Shrestha et al, 2022 ).…”

Section: Myth #2—airway Pressure Release Ventilation Causes Barotraumamentioning

confidence: 99%

Myths and Misconceptions of Airway Pressure Release Ventilation: Getting Past the Noise and on to the Signal

et al. 2022

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In the pursuit of science, competitive ideas and debate are necessary means to attain knowledge and expose our ignorance. To quote Murray Gell-Mann (1969 Nobel Prize laureate in Physics): “Scientific orthodoxy kills truth”. In mechanical ventilation, the goal is to provide the best approach to support patients with respiratory failure until the underlying disease resolves, while minimizing iatrogenic damage. This compromise characterizes the philosophy behind the concept of “lung protective” ventilation. Unfortunately, inadequacies of the current conceptual model–that focuses exclusively on a nominal value of low tidal volume and promotes shrinking of the “baby lung” - is reflected in the high mortality rate of patients with moderate and severe acute respiratory distress syndrome. These data call for exploration and investigation of competitive models evaluated thoroughly through a scientific process. Airway Pressure Release Ventilation (APRV) is one of the most studied yet controversial modes of mechanical ventilation that shows promise in experimental and clinical data. Over the last 3 decades APRV has evolved from a rescue strategy to a preemptive lung injury prevention approach with potential to stabilize the lung and restore alveolar homogeneity. However, several obstacles have so far impeded the evaluation of APRV’s clinical efficacy in large, randomized trials. For instance, there is no universally accepted standardized method of setting APRV and thus, it is not established whether its effects on clinical outcomes are due to the ventilator mode per se or the method applied. In addition, one distinctive issue that hinders proper scientific evaluation of APRV is the ubiquitous presence of myths and misconceptions repeatedly presented in the literature. In this review we discuss some of these misleading notions and present data to advance scientific discourse around the uses and misuses of APRV in the current literature.

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

Cited by 39 publications

References 31 publications

Pulmonary Barotrauma in COVID-19 Patients: Experience From a Secondary Care Hospital in Oman

Pulmonary Barotrauma in COVID-19 Patients: Experience From a Secondary Care Hospital in Oman

The Collateral Damage of the Pandemic on Non-COVID Related Pneumothorax Patients: A Retrospective Cohort Study

Myths and Misconceptions of Airway Pressure Release Ventilation: Getting Past the Noise and on to the Signal

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