Ventilatory associated barotrauma in COVID-19 patients: A multicenter observational case control study (COVI-MIX-study).

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).

• Authors: Luigi Vetrugno, Nadia Castaldo, Alberto Fantin, Cristian Deana, Andrea Cortegiani, Federico Longhini, Francesco Forfori, Gianmaria Cammarota, Domenico Luca Grieco, Miriam Isola, Paolo Navalesi, Salvatore Maurizio Maggiore, Matteo Bassetti, Alfredo Chetta, Marco Confalonieri, Maria De Martino, Giovanni Ferrari, Daniela Francisi, Roberto Luzzati, Simone Meini, Mariano Scozzafava, Emanuela Sozio, Carlo Tascini, Flavio Bassi, Vincenzo Patruno, Italian COVI-MIX Study Group, Edoardo De Robertis, Chiara Aldieri, Lorenzo Ball, Elisa Baratella, Michele Bartoletti, Annalisa Boscolo, Barbara Burgazzi, Vito Catalanotti, Paola Confalonieri, Silvia Corcione, Francesco Giuseppe De Rosa, Alessandro De Simoni, Valerio Del Bono, Roberta Di Tria, Sara Forlani, Daniele Roberto Giacobbe, Bianca Granozzi, Laura Labate, Sara Lococo, Tommaso Lupia, Carola Matellon, Sara Mehrabi, Sabrina Morosi, Silvia Mongodi, Maddalena Mura, Stefano Nava, Riccardo Pol, Tommaso Pettenuzzo, Nguyen Hoang Quyen, Carolina Rescigno, Elda Righi, Barbara Ruaro, Francesco Salton, Silvia Scabini, Angelo Scarda, Marcella Sibani, Evelina Tacconelli, Gennaro Tartaglione, Beatrice Tazza, Eleonora Vania, Pierluigi Viale, Andrea Vianello, Alessandro Visentin, Umberto Zuccon, Francesco Meroi, Danilo Buonsenso
• Journal: Pulmonology (Pulmonology) 2023 Nov-Dec Vol. 29 Issue 6 Pg. 457-468 ISSN: 2531-0437 [Electronic] Spain
• PMID: 36669936 (Publication Type: Multicenter Study, Journal Article)
• Copyright: Copyright © 2022 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

Chemical References

• Oxygen

Topics

• Humans
• COVID-19 (complications, epidemiology)
• Case-Control Studies
• Retrospective Studies
• Hospital Mortality
• Oxygen (therapeutic use)
• Barotrauma (epidemiology, etiology)