VENTILATORY ASSOCIATED BAROTRAUMA IN COVID-19 PATIENTS: A MULTICENTER OBSERVATIONAL CASE CONTROL STUDY (COVI-MIX-STUDY)
- Autori: Vetrugno, Luigi; Castaldo, Nadia; Fantin, Alberto; Deana, Cristian; Cortegiani, Andrea; Longhini, Federico; Forfori, Francesco; Cammarota, Gianmaria; Grieco, Domenico Luca; Isola, Miriam; Navalesi, Paolo; Maggiore, Salvatore Maurizio; Bassetti, Matteo; Chetta, Alfredo; Confalonieri, Marco; De Martino, Maria; Ferrari, Giovanni; Francisi, Daniela; Luzzati, Roberto; Meini, Simone; Scozzafava, Mariano; Sozio, Emanuela; Tascini, Carlo; Bassi, Flavio; Patruno, Vincenzo; De Robertis, Edoardo; Aldieri, Chiara; Ball, Lorenzo; Baratella, Elisa; Bartoletti, Michele; Boscolo, Annalisa; Burgazzi, Barbara; Catalanotti, Vito; Confalonieri, Paola; Corcione, Silvia; De Rosa, Francesco Giuseppe; De Simoni, Alessandro; Bono, Valerio Del; Tria, Roberta Di; Forlani, Sara; Giacobbe, Daniele Roberto; Granozzi, Bianca; Labate, Laura; Lococo, Sara; Lupia, Tommaso; Matellon, Carola; Mehrabi, Sara; Morosi, Sabrina; Mongodi, Silvia; Mura, Maddalena; Nava, Stefano; Pol, Riccardo; Pettenuzzo, Tommaso; Quyen, Nguyen Hoang; Rescigno, Carolina; Righi, Elda; Ruaro, Barbara; Salton, Francesco; Scabini, Silvia; Scarda, Angelo; Sibani, Marcella; Tacconelli, Evelina; Tartaglione, Gennaro; Tazza, Beatrice; Vania, Eleonora; Viale, Pierluigi; Vianello, Andrea; Visentin, Alessandro; Zuccon, Umberto; Meroi, Francesco; Buonsenso, Danilo
- Anno di pubblicazione: 2022
- Tipologia: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/576628
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). ConclusionsC-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). Keywords: COVID-19, acute respiratory failure, barotrauma, pneumothorax, High Flow Nasal Cannula, Invasive Mechanical Ventilation.