Ventilator-induced barotrauma in critically ill patients with COVID-19: a retrospective observational study

Abstract

Background: Ventilator-induced Barotrauma is a complication of intubation that is associated with high driving pressures and positive end-expiratory pressure use. We attempt to determine the incidence of barotrauma in intubated patients with SARS-CoV-2 infection. Methods: Retrospective observation case series of patients with SARS-CoV-2 infection who were intubated in the ICU. Data were collected for a total of 3 months from electronic health records on patient's age, sex, BMI, incidence of barotrauma, total length of intubation and outcome. Results: Ninteen out of the 100 included patients developed barotrauma as defined by radiographic evidence of pneumothorax, pneumomediastinum or subcutaneous emphysema. The average BMI of patients with barotrauma was 32.06 kg/m 2 with an average age of 56.84 years and 9 patients being classified as obese (BMI ≥30 kg/m 2 ). Fourteen out of 19 patients (73%) with barotrauma were intubated for 10 or more days with a median of 16.52 days. The overall mortality rate was noted to be 92% amongst intubated patients. Conclusion: Rate of barotrauma in COVID-19 intubated patients was noted to be 19% in our study, which is on par with the rate of ventilator-induced barotrauma with the previous SARS virus-associated ARDS, and higher than that of the general population with ARDS. Patients who developed barotrauma were also noted to be intubated for a significantly longer duration (16.52 days) as compared to their non-barotrauma counterparts. These findings suggest a need for more data and randomized studies to establish appropriate ventilator management strategies for patients with lung injury associated with COVID-19.

COVID-19 pneumonia imaging follow-up: when and how? A proposition from ESTI and ESR

“…Some patients were reported to develop cystic lung disease, such as pneumatoceles. However, these changes are mostly due to barotrauma during mechanic ventilation (ventilationassociated lung injury) [17,18]. Radiological appearances of cyst formation secondary to COVID-19 are reported, but with relatively low prevalence [19].…”

Pneumothorax in Intubated Patients With COVID-19: A Case Series

“…All of our patients however suffered from severe ARDS due to COVID-19 pneumonia and hence severe lung inflammation, setting up an optimal environment for the pathogenesis of pneumothorax. There have been many other case reports/series, retrospective cohort studies, and meta-analyses that have highlighted this phenomenon of pneumothorax and pneumomediastinum in COVID-19 patients [1][2][3][4][5][6][7][8][9][10][11][12]. It is said that 1% of all patients develop pneumothorax with COVID-19, although almost 7.5% of patients who are admitted develop pneumothorax with a mortality rate of about 58%.…”

Longitudinal Characterization of Cytokine Overproduction: A Case Report in Critically Ill COVID-19 Patients With Hyperinflammation in Bronchoalveolar Lavage

“…Interestingly, we reviewed the levels of cytokines and pathological parameters in Patient 2 and found a visible restoration at the late stage of treatment (after 57 days post-onset), which may have resulted in the good outcome in Patient 2. Commonly, the time period of SARS virus-associated ARDS is 16.52 days post-onset ( 25 ), while the duration of other pulmonary and extrapulmonary ARDS is more than 60 days ( 26 ), however, during the treatment, the duration of COVID-19 ARDS is up to 90 days post-onset ( 27 ). It could be view as a normal period of treatment in this observational study.…”