Background: Pneumomediastinum and pneumothorax are complications which may be associated with barotrauma in mechanically ventilated patients. The current literature demonstrates unclear outcomes regarding barotrauma in critically ill patients with severe COVID-19. The purpose of this study was to examine the incidence of barotrauma in patients with severe COVID-19 pneumonia and its influence on survival.
Study Design And Methods: A retrospective cohort study was performed from March 18, 2020 to May 5, 2020, with follow-up through June 18, 2020, encompassing critically ill intubated patients admitted for COVID-19 pneumonia at an academic tertiary care hospital in Brooklyn, New York. Critically ill patients with pneumomediastinum, pneumothorax, or both (n = 75) were compared to those without evidence of barotrauma (n = 206). Clinical characteristics and short-term patient outcomes were analyzed.
Results: Barotrauma occurred in 75/281 (26.7%) of included patients. On multivariable analysis, factors associated with increased 30-day mortality were elevated age (HR 1.015 [95% CI 1.004-1.027], = 0.006), barotrauma (1.417 [1.040-1.931], = 0.027), and renal dysfunction (1.602 [1.055-2.432], = 0.027). Protective factors were administration of remdesivir (0.479 [0.321-0.714], < 0.001) and receipt of steroids (0.488 [0.370-0.643], < 0.001).
Conclusion: Barotrauma occurred at high rates in intubated critically ill patients with COVID-19 pneumonia and was found to be an independent risk factor for 30-day mortality.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221250 | PMC |
http://dx.doi.org/10.1177/08850666211023360 | DOI Listing |
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