Barotrauma risk is heightened among ventilated patients with COVID-19

  • McGuinness G & al.
  • Radiology
  • 1 Jul 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Among patients receiving mechanical ventilation, risk for barotrauma is higher with COVID-19.
  • Authors: "Lung pathophysiology in COVID-19 may differ from typical pneumonia induced ARDS."

Why this matters

  • The results suggest the need for heightened vigilance and possible reevaluation of ventilator strategies. 
  • Pressure-induced injuries such as pneumothorax and pneumomediastinum are known complications of mechanical ventilation.
  • A coronavirus-affected patient may require modified ventilation techniques.

Key results

  • Barotrauma rates among mechanically ventilated patients:
    • With COVID-19 (n=601):
      • 24% (95% CI, 21%-28%; P<.001 vs historical cohort with acute respiratory distress syndrome>
      • Per-patient rate: 15%.
    • Without COVID-19 (n=196):
      • 0.5% (95% CI, 0%-3%; P<.001 vs patients with covid-19>
    • Historical ARDS cohort (n=285):
      • 11% (95% CI, 8%-15%; P<.001 vs patients with covid-19>
      • Per-patient rate: 10% (P=.04 vs COVID-19 group).
  • On multivariate analysis, barotrauma was associated with mortality only in patients with COVID-19:
    • OR, 2.2 (P=.03). 
      • Of that group, longer length of stay and younger age were associated with barotrauma.

Study design

  • Single-center retrospective cohort study (n=601).
  • Authors compared barotrauma rates among patients undergoing mechanical ventilation, comparing:
    • Those with COVID-19 hospitalized from March 1, 2020 to April 6, 2020;
    • Those without COVID-19 hospitalized over the same period; and
    • Historical control participants with ARDS. 
  • Outcomes: barotrauma risk, per-patient incidence.
  • Funding: None disclosed.

Limitations

  • In one-third of patients, smoking history was unknown.