Occurrence, Risk Factors, and Outcomes of Pulmonary Barotrauma in Critically Ill COVID-19 Patients: A Retrospective Cohort Study

• Published in: Critical care research and practice Vol. 2023; no. 1; p. 4675910
• Main Authors: Al-Dorzi, Hasan M., Al Mejedea, Haifa, Nazer, Reema, Alhusaini, Yara, Alhamdan, Aminah, Al Jawad, Ajyad
• Format: Journal Article
• Language: English
• Published: Egypt Hindawi 22.02.2023; John Wiley & Sons, Inc; Wiley
• Subjects: China; Comparative analysis; Hospital patients; Medical research; Medicine, Experimental; Mortality; Patient outcomes; Saudi Arabia; Saudi Arabia; China
• ISSN: 2090-1305; 2090-1313
• DOI: 10.1155/2023/4675910

Objective. Pulmonary barotrauma has been frequently observed in patients with COVID-19 who present with acute hypoxemic respiratory failure. This study evaluated the prevalence, risk factors, and outcomes of barotrauma in patients with COVID-19 requiring ICU admission. Methods. This retrospective cohort study included patients with confirmed COVID-19 who were admitted to an adult ICU between March and December 2020. We compared patients who had barotrauma with those who did not. A multivariable logistic regression analysis was performed to determine the predictors of barotrauma and hospital mortality. Results. Of 481 patients in the study cohort, 49 (10.2%, 95% confidence interval: 7.6–13.2%) developed barotrauma on a median of 4 days after ICU admission. Barotrauma manifested as pneumothorax (N = 21), pneumomediastinum (N = 25), and subcutaneous emphysema (N = 25) with frequent overlap. Chronic comorbidities and inflammatory markers were similar in both patient groups. Barotrauma occurred in 4/132 patients (3.0%) who received noninvasive ventilation without intubation, and in 43/280 patients (15.4%) who received invasive mechanical ventilation. Invasive mechanical ventilation was the only risk factor for barotrauma (odds ratio: 14.558, 95% confidence interval: 1.833–115.601). Patients with barotrauma had higher hospital mortality (69.4% versus 37.0%; p<0.0001) and longer duration of mechanical ventilation and ICU stay. Barotrauma was an independent predictor of hospital mortality (odds ratio: 2.784, 95% confidence interval: 1.310–5.918). Conclusions. Barotrauma was common in critical COVID-19, with invasive mechanical ventilation being the most prominent risk factor. Barotrauma was associated with poorer clinical outcomes and was an independent predictor of hospital mortality.