The respiratory and ventilator settings (peak airway pressure, plateau pressure, PEEP and P/F ratio (PaO2/FiO2 ratio) preceding the barotrauma were noted. Barotrauma was discovered on a routine chest radiograph (CXR) done daily for patients on respiratory support or on urgent imaging (CXR, point-of-care ultrasound) done in the event of clinical deterioration. Barotrauma was defined as the presence of new onset extra-alveolar air, namely pneumothorax (PTX), pneumo-mediastinum or subcutaneous emphysema. ICU patients with confirmed critical COVID-19 ARDS (C-ARDS) requiring respiratory support in the form of high flow nasal canula (HFNC) /non-invasive ventilator (NIV) or invasive MV (iMV) were included in the study. In this study, we report the incidence of, risk factors for, and outcome after barotrauma in C-ARDS patients on PPRS. Unlike other ARDS, C-ARDS barotrauma has been seen not only in MV patients, but across all categories of positive pressure respiratory support (PPRS). The high incidence of barotrauma in viral pneumonia especially with coronaviruses suggests a unique pathophysiology and clinical challenge different from bacterial pneumonia. Younger age and longer hospitalization were found to be risk factors for developing barotrauma. McGuinness et al reported a 15% incidence of barotrauma in 601 patients with COVID-19 requiring MV support. In several observational studies on C-ARDS, a high incidence of barotrauma was reported. Barotrauma is also associated with adverse outcomes in these patients and often portends a rapid downhill course.
#Pulmonary barotrauma interventuons series
A high incidence of barotrauma (17%) was reported in a case series of critically ill MERS-CoV patients. Viral pneumonia caused by H1N1, SARS-COV1 and MERS-CoV with severe ARDS are also associated with barotrauma. reported an incidence of barotrauma of 10.0% in MV patients with chronic ILD.
Chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD) and Pneumocystis jeroveci pneumonia (PJP) are associated with a higher incidence of barotrauma. The incidence of barotrauma in mechanically ventilated (MV) patients is about 2.9 %. Barotrauma is a known complication of ARDS, prevented by standard ventilation strategies such as low tidal volume ventilation, appropriate PEEP and limiting plateau pressures ≤ 30 cm H 2O. Positive pressure ventilation with PEEP has been used in ARDS management since the first description of ARDS in 1967 by Ashbaugh et al. COVID-19 ARDS (C-ARDS) in the absence of effective therapy is associated with a high mortality, especially in patients with multiple co-morbidities and in the elderly.
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