Abstract
Background:Pneumomediastinum and pneumothorax are complications which may be associated with barotrauma in mechanically ventilated patients. The current literature demonstrates unclear outcomes regarding barotrauma in critically ill patients with severe COVID-19. The purpose of this study was to examine the incidence of barotrauma in patients with severe COVID-19 pneumonia and its influence on survival.Study Design and Methods:A retrospective cohort study was performed from March 18, 2020 to May 5, 2020, with follow-up through June 18, 2020, encompassing critically ill intubated patients admitted for COVID-19 pneumonia at an academic tertiary care hospital in Brooklyn, New York. Critically ill patients with pneumomediastinum, pneumothorax, or both (n = 75) were compared to those without evidence of barotrauma (n = 206). Clinical characteristics and short-term patient outcomes were analyzed.Results:Barotrauma occurred in 75/281 (26.7%) of included patients. On multivariable analysis, factors associated with increased 30-day mortality were elevated age (HR 1.015 [95% CI 1.004-1.027], P = 0.006), barotrauma (1.417 [1.040-1.931], P = 0.027), and renal dysfunction (1.602 [1.055-2.432], P = 0.027). Protective factors were administration of remdesivir (0.479 [0.321-0.714], P < 0.001) and receipt of steroids (0.488 [0.370-0.643], P < 0.001).Conclusion:Barotrauma occurred at high rates in intubated critically ill patients with COVID-19 pneumonia and was found to be an independent risk factor for 30-day mortality.
Highlights
The Coronavirus Disease 2019 (COVID-19) pandemic resulted in a rapid increase in the number of patients requiring mechanical ventilation and intubation
The median age in the barotrauma group was 63.5 (50-72) years versus 69 (60-76) years in patients without barotrauma (P 1⁄4 0.001). Patients in both groups were similar in other characteristics, with the exception of asthma, for which there was a higher prevalence in the barotrauma group compared to the non-barotrauma group (13.3% and 5.9%, P 1⁄4 0.039)
No statistically significant difference was found between the barotrauma group and non-barotrauma group regarding administration of remdesivir (21.3% vs 16.0% respectively, P 1⁄4 0.299) and steroids (68.0% vs 55.3% respectively, P 1⁄4 0.057)
Summary
The Coronavirus Disease 2019 (COVID-19) pandemic resulted in a rapid increase in the number of patients requiring mechanical ventilation and intubation. Pneumomediastinum and pneumothorax are complications which may be associated with barotrauma in mechanically ventilated patients. The current literature demonstrates unclear outcomes regarding barotrauma in critically ill patients with severe COVID-19. Study Design and Methods: A retrospective cohort study was performed from March 18, 2020 to May 5, 2020, with follow-up through June 18, 2020, encompassing critically ill intubated patients admitted for COVID-19 pneumonia at an academic tertiary care hospital in Brooklyn, New York. Conclusion: Barotrauma occurred at high rates in intubated critically ill patients with COVID-19 pneumonia and was found to be an independent risk factor for 30-day mortality
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