Pulmonary Barotrauma in COVID-19 Patients With ARDS on Invasive and Non-Invasive Positive Pressure Ventilation

Rajdev, Kartikeya; Spanel, Alan J.; McMillan, Sean; Lahan, Shubham; Boer, Brian; Birge, Justin; Thi, Meilinh

doi:10.1177/08850666211019719

Cited by 65 publications

(89 citation statements)

References 27 publications

(72 reference statements)

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“…impairment of production and/or reabsorption of surfactant due to ATII cell lysis or apoptosis, altered gene expression patterns with evidence for downregulation of surfactant proteins 10 or a combination of several factors. It has been speculated that increased alveolar surface tension due to loss of surfactant may predispose to pulmonary barotrauma, and our findings thus provide a potential mechanism of the higher incidence of subcutaneous emphysema, pneumothorax, and pneumomediastinum in mechanically ventilated CARDS patients (~ 17%) compared to non-COVID ARDS (~ 5–11%) 11 . Furthermore, case series of CARDS patients have reported improvement in oxygenation and lung compliance following exogenous surfactant although repeated doses are probably needed given that ATII cell destruction may predominate in CARDS.…”

Section: Discussionmentioning

confidence: 64%

Reduced levels of pulmonary surfactant in COVID-19 ARDS

Schousboe

Ronit

Nielsen

et al. 2022

Sci Rep

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To provide novel data on surfactant levels in adult COVID-19 patients, we collected bronchoalveolar lavage fluid less than 72 h after intubation and used Fourier Transform Infrared Spectroscopy to measure levels of dipalmitoylphosphatidylcholine (DPPC). A total of eleven COVID-19 patients with moderate-to-severe ARDS (CARDS) and 15 healthy controls were included. CARDS patients had lower DPPC levels than healthy controls. Moreover, a principal component analysis was able to separate patient groups into distinguishable subgroups. Our findings indicate markedly impaired pulmonary surfactant levels in COVID-19 patients, justifying further studies and clinical trials of exogenous surfactant.

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Section: Discussionmentioning

confidence: 64%

Reduced levels of pulmonary surfactant in COVID-19 ARDS

Schousboe

Ronit

Nielsen

et al. 2022

Sci Rep

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“…A higher incidence of barotrauma was observed in COVID-19 ARDS than non-COVID ARDS in some studies, despite the use of lung-protective ventilation strategy in both groups [ 30 ]. The findings of our meta-analysis substantiated the conclusions of the individual studies regarding the increased occurrence of barotrauma in COVID ARDS.…”

Section: Discussionmentioning

confidence: 99%

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

Shrestha

Sedhai

Budhathoki

et al. 2022

Annals of Medicine &Amp; Surgery

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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.

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“… 20 , 48 The total duration of hospitalization for the current case was 19 days, shorter than that in a previous retrospective cohort report. 51 …”

Section: Discussionmentioning

confidence: 99%

Integrated Chinese herbal medicine and Western medicine successfully resolves spontaneous subcutaneous emphysema and pneumomediastinum in a patient with severe COVID-19 in Taiwan: A case report

Hung

Liao

Chi

et al. 2023

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Case : Serious complications of severe coronavirus disease 2019 (COVID-19) include subcutaneous emphysema (SE) and pneumomediastinum, which are complicated to treat with conventional Western medicine. We report how combining Chinese herbal medicine (CHM) with Western medicine quickly resolved a patient's COVID-19-associated pulmonary complications, shortened hospital stay and improved quality of life. Clinical features and outcome : A 59-year-old male with a history of smoking and tumors was diagnosed with COVID-19 in May 2021. At hospitalization, his oxygen saturation (SpO 2 ) was 80%, he had a continuous severe cough, rapid shallow breathing, spontaneous SE and pneumomediastinum. By Day 4 of hospitalization, his condition was worsening despite standard care, so CHM was added. After 3–5 days, his coughing had lessened and supplementary oxygen therapy was de-escalated. Nine days after starting CHM, the SE had completely resolved and the patient avoided intubation. His WHO OS 10-point Scale score had fallen from 6 to 3 points and the modified Medical Research Council Dyspnea Scale score from 4 to 2 points. He was hospitalized for 19 days. At 1 week post-discharge, the patient could handle most of his daily activities and experienced minor shortness of breath only when performing labor-intensive tasks. At 1 month, his work output was restored to pre-COVID-19 levels. Conclusion : CHM combined with standard Western medicine improved pulmonary function, respiratory rate, blood oxygen saturation and shortened the hospital stay of a patient with severe COVID-19 complicated by SE and pneumomediastinum.

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Pulmonary Barotrauma in COVID-19 Patients With ARDS on Invasive and Non-Invasive Positive Pressure Ventilation

Cited by 65 publications

References 27 publications

Reduced levels of pulmonary surfactant in COVID-19 ARDS

Reduced levels of pulmonary surfactant in COVID-19 ARDS

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

Integrated Chinese herbal medicine and Western medicine successfully resolves spontaneous subcutaneous emphysema and pneumomediastinum in a patient with severe COVID-19 in Taiwan: A case report

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