Barotrauma in COVID-19 acute respiratory distress syndrome: retrospective analysis of the COVADIS prospective multicenter observational database

BMC Anesthesiology

Research

Michael Piagnerelli¹  Gregoire Ottavy²  Jean-Baptiste Lascarrou²  Jean Loup Augy³  Bertrand Sauneuf⁴  Laurent Lefebvre⁵  Christophe Vinsonneau⁶  Filippo Annoni⁷  David Grimaldi⁷  Giuseppe Carbutti⁸  Julien Higny⁹  Romain Courcelle^1,10  Francois Lejeune^1,11  Nicolas Serck^1,12 

[1] Intensive Care. CHU-Charleroi, Marie Curie, Université Libre de Brussels, 140, chaussée de Bruxelles, 6042, Charleroi, Belgium;Médecine Intensive Réanimation, CHU Nantes, 30 Boulevard Jean Monnet, 44093, Nantes Cedex 9, France;Médecine Intensive Réanimation, Hôpital Européen Georges Pompidou, Paris, France;Réanimation - Médecine Intensive, Centre Hospitalier Public du Cotentin, BP208, 50102, Cherbourg-en-Cotentin, France;Réanimation polyvalente, Centre Hospitalier du pays d’Aix, Aix en Provence, France;Service de Médecine Intensive Réanimation, Unité de Sevrage Ventilatoire et Réhabilitation, Centre Hospitalier de Béthune, 27 Rue Delbecque, 62660, Beuvry, France;Soins Intensifs, H.UB, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium;Unité de soins intensifs, CHR Mons-Hainaut, Mons, Belgium;Unité de soins intensifs, CHU Dinant Godinne, site Dinant, Belgium;Unité de soins intensifs, Centres Hospitaliers de Jolimont, La Louvière, Belgium;Unité de soins intensifs, Clinique Notre Dame de Grâce, Gosselies, Belgium;Unité de soins intensifs, Clinique Saint Pierre, Ottignies, Belgium;

关键词: COVID-19;    Mechanical ventilation;    Barotrauma;    Pneumothorax;    Pneumomediastinum;   

DOI  :  10.1186/s12871-023-02093-1

 received in 2022-11-14, accepted in 2023-04-14,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDespite 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.MethodsThis 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. 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.ResultsOf 586 patients, 48 (8.2%) experienced barotrauma, including 35 with pneumothorax, 23 with pneumomediastinum, 1 with pneumoperitoneum, and 6 with subcutaneous emphysema. Median time from mechanical ventilation initiation to barotrauma detection was 3 [0–17] days. All patients received protective ventilation and nearly half (23/48) were in volume-controlled mode. Barotrauma was associated with higher hospital mortality (P < 0.001) even after adjustment on age, sex, comorbidities, PaO2/FiO2 at intubation, plateau pressure at intubation, and center (P < 0.05). The group with barotrauma had a lower mean body mass index (28.6 ± 5.8 vs. 30.3 ± 5.9, P = 0.03) and a higher proportion of patients given corticosteroids (87.5% vs. 63.4%, P = 0.001).ConclusionBarotrauma during mechanical ventilation for COVID-19 ARDS was associated with higher hospital mortality.

【 授权许可】

CC BY   
© The Author(s) 2023. corrected publication 2023

【 图 表 】

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Fig. 1