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Ventilatory associated barotrauma in COVID-19 patients: A multicenter observational case control study (COVI-MIX-study).
Vetrugno, Luigi; Castaldo, Nadia; Fantin, Alberto; Deana, Cristian; Cortegiani, Andrea; Longhini, Federico; Forfori, Francesco; Cammarota, Gianmaria; Grieco, Domenico Luca; Isola, Miriam; Navalesi, Paolo; Maggiore, Salvatore Maurizio; Bassetti, Matteo; Chetta, Alfredo; Confalonieri, Marco; De Martino, Maria; Ferrari, Giovanni; Francisi, Daniela; Luzzati, Roberto; Meini, Simone; Scozzafava, Mariano; Sozio, Emanuela; Tascini, Carlo; Bassi, Flavio; Patruno, Vincenzo; De Robertis, Edoardo; Aldieri, Chiara; Ball, Lorenzo; Baratella, Elisa; Bartoletti, Michele; Boscolo, Annalisa; Burgazzi, Barbara; Catalanotti, Vito; Confalonieri, Paola; Corcione, Silvia; De Rosa, Francesco Giuseppe; De Simoni, Alessandro; Bono, Valerio Del; Tria, Roberta Di; Forlani, Sara; Giacobbe, Daniele Roberto; Granozzi, Bianca; Labate, Laura; Lococo, Sara; Lupia, Tommaso; Matellon, Carola; Mehrabi, Sara; Morosi, Sabrina; Mongodi, Silvia; Mura, Maddalena.
  • Vetrugno L; Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy; Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy. Electronic address: luigi.vetrugno@unich.it.
  • Castaldo N; Pulmonology Unit, Department of Cardiothoracic Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy.
  • Fantin A; Pulmonology Unit, Department of Cardiothoracic Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy.
  • Deana C; Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy.
  • Cortegiani A; Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy; Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy.
  • Longhini F; Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
  • Forfori F; Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, AOUP-Pisa, Italy.
  • Cammarota G; Anesthesia and Intensive Care Service 2, University Hospital of Perugia, Perugia, Italy; Department of Medicine and Surgery, Universiy of Perugia, Perugia, Italy.
  • Grieco DL; Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy; Department of Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Isola M; Department of Medicine, University of Udine, Udine, Italy.
  • Navalesi P; Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy; Department of Medicine (DIMED), University of Padua, Padua, Italy.
  • Maggiore SM; Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy; Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, Chieti, Italy.
  • Bassetti M; Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy.
  • Chetta A; Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
  • Confalonieri M; Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy.
  • De Martino M; Department of Medicine, University of Udine, Udine, Italy.
  • Ferrari G; Pneumologia e Unità di Terapia Semi Intensiva Respiratoria, AO Umberto I Mauriziano, Turin, Italy.
  • Francisi D; Department of Infectious Disease "S. Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy.
  • Luzzati R; Infectious Disease Unit, University of Trieste, Trieste, Italy.
  • Meini S; U.O. Medicina Interna, Felice Lotti Hospital, Azienda USL Toscana Nord-Ovest, Pontedera, Italy.
  • Scozzafava M; Respiratory High Dependecy Unit - General Hospital Lodi, Lodi, Italy.
  • Sozio E; Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy.
  • Tascini C; Department of Medicine, University of Udine, Udine, Italy; Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy.
  • Bassi F; Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy.
  • Patruno V; Pulmonology Unit, Department of Cardiothoracic Surgery, Health Integrated Agency of Friuli Centrale, Udine, Italy.
  • De Robertis E; Anesthesia and Intensive Care Service 2, University Hospital of Perugia, Perugia, Italy; Department of Medicine and Surgery, Universiy of Perugia, Perugia, Italy.
  • Aldieri C; Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy.
  • Ball L; Anesthesia and Intensive Care, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
  • Baratella E; Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy.
  • Bartoletti M; Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy.
  • Boscolo A; Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy.
  • Burgazzi B; Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
  • Catalanotti V; Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy.
  • Confalonieri P; Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy; University of Trieste, Trieste, Italy.
  • Corcione S; Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy.
  • De Rosa FG; Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy; Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy.
  • De Simoni A; Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
  • Bono VD; Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy.
  • Tria RD; Pneumologia e Unità di Terapia Semi Intensiva Respiratoria, AO Umberto I Mauriziano, Turin, Italy.
  • Forlani S; Pulmonary Medicine Unit, Lodi General Hospital, Lodi, Italy.
  • Giacobbe DR; Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy.
  • Granozzi B; Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy.
  • Labate L; Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy.
  • Lococo S; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
  • Lupia T; Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy.
  • Matellon C; Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy.
  • Mehrabi S; Infectious Diseases Division, Diagnostics and Public Health Department, University of Verona, Verona, Italy.
  • Morosi S; Department of Infectious Disease "S. Maria della Misericordia" Hospital, University of Perugia, Perugia, Italy.
  • Mongodi S; Anaesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  • Mura M; U.O. Medicina Interna, Felice Lotti Hospital, Azienda USL Toscana Nord-Ovest, Pontedera, Italy.
Pulmonology ; 2022 Nov 24.
Article in English | MEDLINE | ID: covidwho-2236646
ABSTRACT

BACKGROUND:

The risk of barotrauma associated with different types of ventilatory support is unclear in COVID-19 patients. The primary aim of this study was to evaluate the effect of the different respiratory support strategies on barotrauma occurrence; we also sought to determine the frequency of barotrauma and the clinical characteristics of the patients who experienced this complication.

METHODS:

This multicentre retrospective case-control study from 1 March 2020 to 28 February 2021 included COVID-19 patients who experienced barotrauma during hospital stay. They were matched with controls in a 11 ratio for the same admission period in the same ward of treatment. Univariable and multivariable logistic regression (OR) were performed to explore which factors were associated with barotrauma and in-hospital death.

RESULTS:

We included 200 cases and 200 controls. Invasive mechanical ventilation was used in 39.3% of patients in the barotrauma group, and in 20.1% of controls (p<0.001). Receiving non-invasive ventilation (C-PAP/PSV) instead of conventional oxygen therapy (COT) increased the risk of barotrauma (OR 5.04, 95% CI 2.30 - 11.08, p<0.001), similarly for invasive mechanical ventilation (OR 6.24, 95% CI 2.86-13.60, p<0.001). High Flow Nasal Oxygen (HFNO), compared with COT, did not significantly increase the risk of barotrauma. Barotrauma frequency occurred in 1.00% [95% CI 0.88-1.16] of patients; these were older (p=0.022) and more frequently immunosuppressed (p=0.013). Barotrauma was shown to be an independent risk for death (OR 5.32, 95% CI 2.82-10.03, p<0.001).

CONCLUSIONS:

C-PAP/PSV compared with COT or HFNO increased the risk of barotrauma; otherwise HFNO did not. Barotrauma was recorded in 1.00% of patients, affecting mainly patients with more severe COVID-19 disease. Barotrauma was independently associated with mortality. TRIAL REGISTRATION this case-control study was prospectively registered in clinicaltrial.gov as NCT04897152 (on 21 May 2021).
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2022 Document Type: Article