Data collectionīetween March 10 and December 31, 2020, consecutive COVID-19 patients admitted to the participating ICUs were screened for eligibility, and those who met the inclusion and non-inclusion criteria were enrolled in the cohort. Non-inclusion criteria were cardiac arrest before ICU admission, extracorporeal membrane oxygenation within 24 h after ICU admission, Gold stage III or IV chronic obstructive pulmonary disease, and home oxygen therapy. Patients with negative COVID-19 polymerase chain reaction tests were not included even when they had computed tomography abnormalities typical for COVID-19. Inclusion criteria were age older than 18 years, moderate-to-severe ARDS according to the Berlin definition (PaO 2/FiO 2 < 200 mmHg with positive end-expiratory pressure ≥ 5 mmHg during invasive mechanical ventilation), and positive COVID-19 reverse-transcriptase polymerase-chain-reaction test on a sample from any site. COVADIS prospectively included patients admitted between March and December 2020 to any of 12 ICUs, including 7 in Belgium and 5 in France. This was a retrospective analysis of the data from the COVADIS observational cohort study. This report complies with STROBE guidelines. The secondary objectives were to evaluate the incidence, risk factors, and other outcomes of barotrauma. The primary objective of this retrospective analysis of the prospective multicenter observational COVADIS study was to determine whether barotrauma was associated with hospital mortality. Also, rare cases of barotrauma have been reported in spontaneously breathing patients with COVID-19. Other studies found barotrauma in up to 26.7% of patients. Another atypical feature may be a higher risk of barotrauma: a literature review published in March 2022 showed barotrauma in 14.7% of COVID-19 patients compared to 6.3% of patients with ARDS due to other causes. Compared to other forms of ARDS, COVID-19 ARDS has been described as atypical given the higher lung compliance and gas volume at a given PaO 2//FiO 2 ratio. Protective ventilation strategies that limit ventilation volumes and pressures are recommended to avoid these complications, notably in patients with ARDS. Barotrauma is a well-documented complication of non-COVID-19 viral ARDS requiring mechanical ventilation for whatever reason. The pressures and volumes applied by the ventilator play a key role, although factors that weaken the alveolar wall may also be involved. īarotrauma from mechanical ventilation is defined clinically as alveolar rupture manifesting as pneumomediastinum, pneumothorax, pneumopericardium, and/or subcutaneous emphysema. Among patients admitted for COVID-19, 8–32% require admission to the intensive care unit (ICU) and 19% are placed on invasive mechanical ventilation. The most common cause of death in coronavirus virus disease 2019 (COVID-19) is acute respiratory distress syndrome (ARDS) with hypoxemic respiratory failure. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has infected at least 460 million people worldwide, and the official count of 6 million deaths is probably an underestimation. Conclusionīarotrauma during mechanical ventilation for COVID-19 ARDS was associated with higher hospital mortality. 30.3 ± 5.9, P = 0.03) and a higher proportion of patients given corticosteroids (87.5% vs. The group with barotrauma had a lower mean body mass index (28.6 ± 5.8 vs. Barotrauma was associated with higher hospital mortality ( P < 0.001) even after adjustment on age, sex, comorbidities, PaO 2/FiO 2 at intubation, plateau pressure at intubation, and center ( P < 0.05). All patients received protective ventilation and nearly half (23/48) were in volume-controlled mode. Median time from mechanical ventilation initiation to barotrauma detection was 3 days. Of 586 patients, 48 (8.2%) experienced barotrauma, including 35 with pneumothorax, 23 with pneumomediastinum, 1 with pneumoperitoneum, and 6 with subcutaneous emphysema. The primary objective was to determine whether barotrauma was associated with ICU mortality (censored on day 90), and the secondary objective was to identify factors associated with barotrauma. This prospective observational multicenter study included consecutive patients with moderate-to-severe COVID-19 ARDS requiring invasive mechanical ventilation and managed at any of 12 centers in France and Belgium between March and December 2020. Despite evidence suggesting a higher risk of barotrauma during COVID-19-related acute respiratory distress syndrome (ARDS) compared to ARDS due to other causes, data are limited about possible associations with patient characteristics, ventilation strategy, and survival.
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