Incidence of Barotrauma in COVID-19 Patients Requiring Mechanical Ventilation: A Retrospective Study in a Community Hospital.

ABSTRACT

Background and aim Acute respiratory distress syndrome (ARDS) is a severe complication of COVID-19 and traditional ventilation strategies using ARDSNet protocol, including low tidal volumes, appear to cause barotrauma in COVID-19 patients at a higher rate than non-COVID-19 ARDS patients. The purpose of our study was to determine if COVID-19 patients with ARDS undergoing mechanical ventilation at St. Joseph's Medical Center (SJMC) developed barotrauma at a higher rate than non-COVID-19 ARDS patients. Methods and materials This study was a retrospective chart review of all patients admitted to critical care units at SJMC with COVID-19 infection and requiring mechanical ventilation from March 1, 2020 to September 30, 2020. The sample included adult patients (aged 18 and above) with the International Classification of Diseases (ICD) 10 code for COVID-19 (U07.1) and patients who were placed on mechanical ventilation for longer than 24 hours, from March 1, 2020 to September 30, 2020. Barotrauma was confirmed via radiographic imaging including chest X-ray, CT, or CT angiography (CTA).  Results One hundred and forty COVID-19 patients underwent mechanical ventilation for longer than 24 hours from March 1, 2020 to September 30, 2020 at our facility. Twenty-six COVID-19 patients (18.6%) met our inclusion criteria (development of barotrauma during hospital admission) of which 25 patients (17.9%) underwent mechanical (invasive and/or non-invasive) ventilation prior to the development of barotrauma. Around 80% of the patients were on non-invasive mechanical ventilation prior to intubation and invasive mechanical ventilation. The categorical breakdown of barotrauma was as follows pneumothorax 65.4%, subcutaneous emphysema 61.5%, pneumomediastinum 34.6%, and pneumoperitoneum 7.7%. None of the included patients had any previous history of documented barotrauma. Prior to the time of barotrauma, 17 patients were on volume control, seven were on pressure control, and one was not on mechanical ventilation. Of the 17 patients on volume control, only one patient was above the ARDSNet guideline of 6-8 mL/kg ideal body weight (IBW). In comparison to ARDS patients at SJMC in 2019, only two out of 28 patients (7.14%) developed barotrauma during mechanical ventilation.  Conclusions Patients with COVID-19 who underwent mechanical ventilation developed barotrauma at a higher rate than traditional non-COVID-19 patients with ARDS.