Increased Incidence of Barotrauma in Patients with COVID-19 on Invasive Mechanical Ventilation

Abstract

A t New York University Langone Health at the height of the coronavirus disease 2019 (COVID-19) pandemic, 22% of hospitalized patients diagnosed with COVID-19 infection required invasive mechanical ventilation (IMV) (1). We noted many patients with COVID-19 infection who developed pneumothorax, pneumomediastinum, and pneumopericardium, and in some cases, at multiple separate time points. Given this observation, we hypothesized that barotrauma related to IMV was elevated in patients with COVID-19 infection. The purpose of this study was to evaluate the rate of barotrauma in patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and who required IMV compared with other patients in the same institution during the same period who also required IMV, and to a temporally remote (pre-COVID-19) historical cohort of patients who required IMV support in the setting of acute respiratory distress syndrome (ARDS). Materials and Methods This retrospective study was performed with institutional review board waiver of authorization and consent (is20-00582) given the current urgent conditions created by the pandemic. Study Population The New York University Langone Health electronic medical record system (Epic Systems, Verona, Wis) was searched for patients age 18 years or older seen in our emergency department between March 1, 2020, and April 6, 2020, with chest imaging within 24 hours of nasopharyngeal or oropharyngeal swab testing for SARS-CoV-2. Test assay techniques are detailed in Appendix E1 (online). Patients with positive real-time reverse transcription polymerase chain reaction assays were deemed COVID-19 positive, and those with negative results were deemed COVID-19 negative. COVID-19 testing was performed in all patients who presented to the emergency

Pneumomediastinum and subcutaneous emphysema in COVID-19: barotrauma or lung frailty?

“…This is in agreement with a previously published study on more than 5000 mechanically ventilated patients, in which the presence of air outside the tracheobronchial tree (pneumothorax, pneumomediastinum, subcutaneous emphysema) was unrelated to airway pressures and tidal volume [11]. Therefore, the automatic association between barotrauma and presence of air outside the tracheobronchial tree in mechanically ventilated patients [11,12] should be reconsidered. Actually, the term "barotrauma" should be used in presence of air outside the tracheobronchial tree only when concurrent with elevated airway pressure.…”

Chest CT in COVID-19: What the Radiologist Needs to Know

“…For instance, cavitating lung lesions can manifest in patients with COVID-19 (Fig 6), which may be due to mechanical ventilator-induced lung injury. Of interest, authors of a study (52) reported that barotrauma (pneumothorax, pneumomediastinum) occurs in approximately 15% of patients with COVID-19 who require invasive mechanical ventilation, and that it is more likely to occur in younger patients. Pericardial effusion may be seen as a complication in the setting of cardiac injury.…”

Incidence of Barotrauma in Patients With COVID-19 Pneumonia During Prolonged Invasive Mechanical Ventilation – A Case-Control Study

“…MyGuinness et al reported a rate of barotrauma of 15% in a mixed collective of invasive ventilated COVID-19 patients. 4 However, this publication mainly focused on radiological findings and did not investigate a possible association between barotrauma and respirator settings.…”