Incidence of Barotrauma in Patients With COVID-19 Pneumonia During Prolonged Invasive Mechanical Ventilation - A Case-Control Study.
J Intensive Care Med
; 36(4): 477-483, 2021 Apr.
Article
in English
| MEDLINE | ID: covidwho-788460
ABSTRACT
BACKGROUND:
SARS-CoV2 can cause pulmonary failure requiring prolonged invasive mechanical ventilation (MV). Lung protective ventilation strategies are recommended in order to minimize ventilator induced lung injury. Whether patients with COVID-19 have the same risk for complications including barotrauma is still unknown. Therefore, we investigated barotrauma in patients with COVID-19 pneumonia requiring prolonged MV.METHODS:
All patients meeting diagnosis criteria for ARDS according to the Berlin Definition, with PCR positive SARS-CoV2 infection and prolonged mechanical ventilation, defined as ≥2 days, treated at our ARDS referral center between March and April 2020 were included in a retrospective registry analysis. Complications were detected by manual review of all patient data including respiratory data, imaging studies, and patient files.RESULTS:
A total of 20 patients with severe COVID-19 pulmonary failure (Overall characteristics median age 61 years, female gender 6, median duration of MV 22 days) were analyzed. Eight patients (40%) developed severe barotrauma during MV (after median 18 days, range 1-32) including pneumothorax (5/20), pneumomediastinum (5/20), pneumopericard (1/20), and extended subcutaneous emphysema (5/20). Median respirator settings 24 hours before barotrauma were Peak inspiratory pressure (Ppeak) 29 cm H2O (range 27-35), positive end-expiratory pressure (PEEP) 14 cm H2O (range 5-24), tidal volume (VT) 5.4ml/kg predicted body weight (range 0.4-8.6), plateau pressure (Pplateau) 27 cm H2O (range 19-30). Mechanical ventilation was significantly more invasive on several occasions in patients without barotrauma.CONCLUSION:
Barotrauma in COVID-19 induced respiratory failure requiring mechanical ventilation was found in 40% of patients included in this registry. Our data suggest that barotrauma in COVID-19 may occur even when following recommendations for lung protective MV.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Respiration, Artificial
/
Respiratory Insufficiency
/
Barotrauma
/
Ventilators, Mechanical
/
COVID-19
Type of study:
Observational study
/
Prognostic study
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
English
Journal:
J Intensive Care Med
Journal subject:
Critical Care
Year:
2021
Document Type:
Article
Affiliation country:
0885066620954364
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