1 research outputs found
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