Barotrauma in patients with severe coronavirus disease 2019-retrospective observational study

Petra Bajto; Ivana Saric; Josipa Domazet Bugarin; Nikola Delic; Svjetlana Dosenovic; Darko Ilic; Sanda Stojanovic Stipic; Bozidar Duplancic; Lenko Saric

doi:10.21037/jtd-23-677

Barotrauma in patients with severe coronavirus disease 2019-retrospective observational study

J Thorac Dis. 2023 Oct 31;15(10):5297-5306. doi: 10.21037/jtd-23-677. Epub 2023 Sep 22.

Authors

Petra Bajto¹, Ivana Saric¹, Josipa Domazet Bugarin¹, Nikola Delic¹, Svjetlana Dosenovic¹, Darko Ilic¹, Sanda Stojanovic Stipic¹, Bozidar Duplancic¹, Lenko Saric¹

Affiliation

¹ Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Split, Croatia.

Abstract

Background: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Although it is known that the COVID-19 acute respiratory distress syndrome (ARDS) is associated with higher incidence of pulmonary barotrauma, unique mechanisms causing the aforementioned complication are still to be investigated. The goal of this research was to investigate the incidence of barotrauma among COVID-19 patients treated in the intensive care unit (ICU) and to examine different clinical outcomes among those subjects.

Methods: This retrospective observational cohort study included adult COVID-19 patients admitted to ICU from September 1, 2020, to February 28, 2022. All admitted subjects received invasive respiratory support. Subjects were divided into two groups based on occurrence of pulmonary barotrauma. Data were collected from available electronical medical records.

Results: In the study period, a total of 900 subjects met inclusion criteria. Pulmonary barotrauma occurred in 88 (9.8%) of them. Subcutaneous emphysema developed in 73 (83%), pneumomediastinum in 68 (77.3%) and pneumothorax in 54 (61.4%) subjects. A small group of subjects developed less common complications like pneumoperitoneum (8 subjects, 9.1%) and pneumopericardium (2 subjects, 2.3%). Survival rate was higher in control than in barotrauma group [396 (48.8%) vs. 22 (25.0%), P<0.05]. There was also a significant difference between two groups in PaO₂/FiO₂ ratio on admission, duration of non-invasive respiratory support before mechanical ventilation, duration of mechanical ventilation and duration of ICU and hospital stay, all in favour of control group.

Conclusions: Development of barotrauma in patients with severe forms of COVID-19 disease and in need of respiratory support is associated with longer ICU and hospital stay as well as lower survival rates at hospital discharge. Further efforts are needed in understanding mechanism in developing barotrauma and finding new prevention and treatment options.

Keywords: Coronavirus disease 2019 (COVID-19); barotrauma; intensive care unit (ICU); positive pressure ventilation; ventilator induced lung injury (VILI).