6533b838fe1ef96bd12a488e
RESEARCH PRODUCT
Ventilatory associated barotrauma in COVID-19 patients: A multicenter observational case control study (COVI-MIX-study)
Luigi VetrugnoNadia CastaldoAlberto FantinCristian DeanaAndrea CortegianiFederico LonghiniFrancesco ForforiGianmaria CammarotaDomenico Luca GriecoMiriam IsolaPaolo NavalesiSalvatore Maurizio MaggioreMatteo BassettiAlfredo ChettaMarco ConfalonieriMaria De MartinoGiovanni FerrariDaniela FrancisiRoberto LuzzatiSimone MeiniMariano ScozzafavaEmanuela SozioCarlo TasciniFlavio BassiVincenzo PatrunoEdoardo De RobertisChiara AldieriLorenzo BallElisa BaratellaMichele BartolettiAnnalisa BoscoloBarbara BurgazziVito CatalanottiPaola ConfalonieriSilvia CorcioneFrancesco Giuseppe De RosaAlessandro De SimoniValerio Del BonoRoberta Di TriaSara ForlaniDaniele Roberto GiacobbeBianca GranozziLaura LabateSara LococoTommaso LupiaCarola MatellonSara MehrabiSabrina MorosiSilvia MongodiMaddalena MuraStefano NavaRiccardo PolTommaso PettenuzzoNguyen Hoang QuyenCarolina RescignoElda RighiBarbara RuaroFrancesco SaltonSilvia ScabiniAngelo ScardaMarcella SibaniEvelina TacconelliGennaro TartaglioneBeatrice TazzaEleonora VaniaPierluigi VialeAndrea VianelloAlessandro VisentinUmberto ZucconFrancesco MeroiDanilo Buonsensosubject
Pulmonary and Respiratory MedicineHigh flow nasal cannulaAcute respiratory failure; Barotrauma; COVID-19; High flow nasal cannula; Invasive mechanical ventilation; PneumothoraxBarotraumaCOVID-19PneumothoraxInvasive mechanical ventilationAcute respiratory failuredescription
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 1:1 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). ConclusionsC-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). Keywords: COVID-19, acute respiratory failure, barotrauma, pneumothorax, High Flow Nasal Cannula, Invasive Mechanical Ventilation.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2022-11-02 |