4 research outputs found
EBUS-Guided Cryobiopsy of Mediastinal Lymphonodes: The First Case Report
No abstract availabl
Medical thoracoscopy without pleural fluid: How I do it
Thoracoscopy is commonly used minimally invasive procedure in the field of interventional pulmonology. While medical thoracoscopy is the widely preferred modality, modifications to the technique and expansion in the scope of its utility have always challenged the conventional approach. We describe a modified technique of medical thoracoscopy in absence of pleural effusion also known as dry thoracoscopy under sedation and local anaesthesia
VENTILATORY ASSOCIATED BAROTRAUMA IN COVID-19 PATIENTS: A MULTICENTER OBSERVATIONAL CASE CONTROL STUDY (COVI-MIX-STUDY)
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