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Time dependency and unique etiology of barotrauma in COVID-19: A retrospective cohort study with landmark analysis

Takafumi Kabuto1, Ryutaro Seo2, Chisato Miyakoshi3

  • 1Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.

Plos One
|March 15, 2023
PubMed

Insights

Barotrauma in patients with coronavirus disease 2019 is a significant mortality risk, particularly in the later stages. This lung injury is linked to heterogeneous inflammation and potential lung destruction.

Area of Science:

  • Pulmonology
  • Critical Care Medicine
  • Pathology

Background:

  • Barotrauma is a common complication in patients with coronavirus disease 2019 (COVID-19).
  • Previous research indicates barotrauma as a mortality risk factor, but its temporal aspects and underlying causes remain unclear.
  • This study aimed to clarify the time-dependent nature and pathophysiology of barotrauma in COVID-19.

Purpose of the Study:

  • To investigate the time-dependent characteristics of barotrauma in COVID-19 patients.
  • To elucidate the etiology of COVID-19-related barotrauma.
  • To assess the impact of barotrauma on 90-day survival in intubated COVID-19 patients.

Main Methods:

  • Retrospective review of intubated COVID-19 patients (March 2020 - May 2021).
  • Comparison of 90-day survival between barotrauma and non-barotrauma groups using landmark analyses at 7, 14, 21, and 28 days.
  • Evaluation of surgically treated pneumothorax cases and pathological findings.

Main Results:

  • Barotrauma occurred in 22.9% of 192 reviewed patients.
  • The barotrauma group had significantly worse 90-day survival (47.7% vs. 82.4%, p < 0.001).
  • Landmark analyses showed no difference at 7 days but significantly worse survival in the barotrauma group at 14, 21, and 28 days.
  • Pathology revealed subpleural hematoma, pulmonary cysts, and heterogeneous lung inflammation.

Conclusions:

  • Barotrauma is a poor prognostic indicator for COVID-19, especially in the later disease phases.
  • Heterogeneous inflammation appears to be a key factor in the mechanism of barotrauma.
  • Barotrauma may serve as an important indicator of lung damage in COVID-19.
Abstract

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