Pulmonary Barotrauma in COVID-19 Patients: Invasive versus Noninvasive Positive Pressure Ventilation

Area of Science:

• Critical Care Medicine
• Pulmonology
• Infectious Diseases

Background:

• COVID-19 patients requiring respiratory support are susceptible to pulmonary barotrauma (PBT).
• Understanding risk factors for PBT in COVID-19 is crucial for optimizing ventilation strategies.

Purpose of the Study:

• To determine the incidence and outcomes of PBT in COVID-19 patients on positive pressure ventilation (PPV).
• To identify risk factors and predictors of PBT in this population.

Main Methods:

• Retrospective analysis of adult COVID-19 patients receiving PPV from October to December 2020.
• Patients were categorized based on PBT development (subcutaneous emphysema, pneumothorax, pneumomediastinum).
• Demographics, laboratory data, ventilation modes, and outcomes were analyzed.

Main Results:

• 21.8% of hospitalized COVID-19 patients received PPV; 21.3% of those developed PBT.
• Invasive ventilation was associated with significantly lower odds of PBT (OR = 0.891).
• Younger patients and those with diabetes mellitus had lower PBT risk; lower PO2/FIO2 ratio predicted higher PBT risk.

Conclusions:

• COVID-19 patients on PPV face a substantial risk of PBT.
• Invasive PPV demonstrated a protective association against PBT compared to noninvasive methods.
• Delaying intubation did not appear to mitigate the risk of PBT.