BAROTRAUMA IN COVID-19 PATIENTS REQUIRING NON-INVASIVE VENTILATION

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TYPE: Case Report TOPIC: Imaging INTRODUCTION: Pulmonary barotrauma (PB) is defined as the presence of extra alveolar air due to lung injury. Although barotrauma is a rare complication of patients who receive non-invasive ventilation (NIV), several cases of barotrauma have been reported in COVID-19 patients under NIV. CASE PRESENTATION: Case 1: 75-y-old man, no relevant medical record, admitted in the ER with fever and shortness of breath. He presented with hypoxemic respiratory failure and tested positive for SARS-CoV-2. Due to a worsening of the respiratory failure, it was necessary to institute non-invasive ventilation (NIV). A chest computed tomography (CT) scan was preformed and revealed the presence of pneumomediastinum and subcutaneous emphysema. The patient evolved favorably. Case 2: 73-y-old man, previously autonomous, admitted in the ER due to cough, fever and shortness of breath; the patient tested positive for SARS-CoV-2. He presented with severe hypoxemic respiratory failure and initiated NIV in the ER. Nevertheless, he maintained respiratory failure and underwent a chest CT, which identified pneumomediastinum, pneumothorax and subcutaneous emphysema. He was admitted in the ICU and initiated invasive mechanical ventilation; however, the evolution turned out to be unfavorable and the patient died. DISCUSSION: Although evidence regarding the pathophysiology of COVID-19 is still scarce, the apparent high incidence of barotrauma in COVID-19 patients, seems to be related to an excessive inflammatory response that leads to acute lung injury. CONCLUSIONS: It is important to raise awarness for this possible complication of NIV, since barotrauma has been associated with longer hospitalization and higher morbidity and mortality. DISCLOSURE: Nothing to declare. KEYWORD: Barotrauma; COVID-19; Non-invasive ventilation