Barotrauma in critically ill COVID-19 patients: a retrospective case-control study

Abstract

Background:There is increased incidence of barotrauma in COVID-19 patients, probably due to disease pathology, oxygen therapy and coughing. We aimed to retrospectively compare the characteristics, associations and outcomes of COVID-19 patients with and without barotrauma in the intensive care unit (ICU).Methods: All adults admitted between October 1st and December 31st 2020 in the ICUs of a COVID-19 hospital were retrospectively analysed for presence of a 'barotrauma event' (presence of at least one of pneumothorax, pneumomediastinum, subcutaneous emphysema or bronchopleural fistula). A control group was formed by matching each case to a patient belonging to the same gender and age range from the remaining patients in the cohort, i.e., those without barotrauma. Demographic details, ICU stay details, details of oxygen therapy and ventilation, and outcomes were noted and compared.Results: Of 827 patients, 30 patients (3.6%) developed barotrauma events. The typical patient was middle aged (median age 55.5 years) and male (73.3%). The mortality rate was significantly higher in the barotrauma group (83.3% vs. 43.3%, P < 0.001), and odds of survival decreased by 85% if barotrauma occurred (OR 0.15; 95% CI: 0.46-0.51). Patients who developed barotrauma spent a longer time on a high-flow nasal cannula (median 6.7 vs. 1.73 days, P = 0.04), and mechanical ventilation (median 9.54 vs. 0.867 days, P < 0.001), and had a longer ICU stay (median 15.5 vs. 9 days, P = 0.014). The most common event was pneumothorax (26/30).Conclusions: Barotrauma in the COVID-19 ICU is associated with prolonged ICU stay, higher odds of mortality and longer duration spent on mechanical ventilation and a high-flow nasal cannula.

Occurrence, Risk Factors, and Outcomes of Pulmonary Barotrauma in Critically Ill COVID-19 Patients: A Retrospective Cohort Study

“…Barotrauma was associated with worse outcomes in our study, including a longer duration of IMV, a longer stay in the ICU, and higher mortality. These findings were also observed in other studies [ 18 , 25 ]. Additionally, the rates of ICU and hospital mortality were significantly higher in patients with barotrauma compared with those without barotrauma, and the multivariable regression analysis showed that barotrauma was associated with an almost threefold increased risk of death (OR: 2.784, 95% CI: 1.310–5.918).…”

“…Additionally, the rates of ICU and hospital mortality were significantly higher in patients with barotrauma compared with those without barotrauma, and the multivariable regression analysis showed that barotrauma was associated with an almost threefold increased risk of death (OR: 2.784, 95% CI: 1.310–5.918). Higher mortality with barotrauma was also observed in other studies [ 5 , 18 , 25 ]. Whether the increased mortality was solely due to barotrauma or that barotrauma indicated a more severe respiratory illness is not clear.…”

Pulmonary Barotrauma in COVID-19 Patients: Experience From a Secondary Care Hospital in Oman

“…In a retrospective case-control study by Venkateswaran et al, the authors compared the characteristics, associations, and outcomes of COVID-19 patients admitted to the ICU with and without barotrauma [37]. The number of patients admitted over three months was 827, out of which 30 patients (3.6%) developed barotrauma of various types (pneumothorax was most common, in 26 out of 30 patients).…”

Barotrauma in critically ill patients with COVID-19: the more we learn, the less we know! Response to the commentary

“…Dear Editor, We thank the authors of the commentary [1] for their comprehensive analysis of the article [2] and for raising some pertinent points. The authors correctly point out that the flow rate setting is an important factor in the use of a high-flow nasal cannula (HFNC), with low flow rates facilitating patient comfort and ease of use, and higher flow rates being more effective at improving oxygenation [3].…”