Ventilatory associated barotrauma in COVID-19 patients: A multicenter observational case control study (COVI-MIX-study). in Pulmonology / Pulmonology. 2022 Nov 24:S2531-0437(22)00260-4. doi: 10.1016/j.pulmoe.2022.11.002.
2022
AO Cuneo
AO Ordine Mauriziano
ASL Cuneo 1
ASL Asti
Tipo pubblicazione
Journal Article
Autori/Collaboratori (71)Vedi tutti...
Buonsenso D
Department of Medicine, University of Udine, Udine, Italy.
Meroi F
Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy.
Zuccon U
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
et alii...
Abstract
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). CONCLUSIONS: C-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).
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PMID : 36669936
DOI : 10.1016/j.pulmoe.2022.11.002
Keywords
Pneumothorax; Invasive mechanical ventilation; High flow nasal cannula; COVID-19; Acute respiratory failure; Barotrauma;