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High Incidence of Barotrauma in Patients With Severe Coronavirus Disease 2019

Michael R Kahn1, Richard L Watson2, Jay T Thetford1

  • 1Department of Medicine, 12222UCLA-Olive View Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Journal of Intensive Care Medicine
|March 16, 2021
PubMed

Insights

Critically ill COVID-19 patients experienced a high incidence of barotrauma, particularly those on invasive mechanical ventilation. This lung injury was linked to longer hospital stays and increased tracheostomy rates.

Area of Science:

  • Critical Care Medicine
  • Pulmonology
  • Infectious Diseases

Background:

  • Barotrauma is a known complication of mechanical ventilation in Acute Respiratory Distress Syndrome (ARDS).
  • The incidence of barotrauma in patients with coronavirus disease 2019 (COVID-19) is not well-established.
  • Understanding barotrauma incidence in COVID-19 is crucial for optimizing patient management.

Purpose of the Study:

  • To determine the incidence of barotrauma in critically ill COVID-19 patients.
  • To explore the implications and associated factors of barotrauma in this population.

Main Methods:

  • Retrospective cohort study design.
  • Inclusion of 75 critically ill COVID-19 patients admitted to an intensive care unit (ICU).
  • Analysis of barotrauma incidence based on ventilation type (invasive mechanical ventilation [IMV] vs. non-invasive ventilation [NIV]).

Main Results:

  • 21% of severe COVID-19 patients developed barotrauma, with higher rates in those on IMV (33%) versus NIV (8%).
  • Barotrauma was associated with increased tracheostomy rates, longer ICU stays (17 vs. 7 days), and longer hospitalization (26 vs. 14 days).
  • Patients with barotrauma showed a trend towards higher mortality (56% vs. 37%) and longer IMV duration.

Conclusions:

  • Critically ill COVID-19 patients exhibit a high incidence of barotrauma, exceeding rates typically seen in ARDS.
  • The pathophysiology of COVID-19 may contribute to this increased susceptibility to lung injury.
  • Lung-protective ventilation strategies remain essential for managing these patients.
Abstract

Keywords:
COVID-19adultartificialbarotraumainflammationphysiologyrespirationrespiratory distress syndrome

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