Jones Eben, Gould Allon, Pillay Timesh D, Khorasanee Reza, Sykes Richard, Bazo-Alvarez Juan Carlos, Cox Charlie, Shurovi Badrun, Isted Alexander, Simpson Thomas, Jennings Mick, Breeze Richard, Khaliq Waqas
Department of Critical Care, University Hospital Lewisham, London, United Kingdom.
Department of General Medicine, University Hospital Lewisham, London, United Kingdom.
Crit Care Explor. 2020 Sep 17;2(9):e0210. doi: 10.1097/CCE.0000000000000210. eCollection 2020 Sep.
Management of severe coronavirus disease 2019 relies on advanced respiratory support modalities including invasive mechanical ventilation, continuous positive airway pressure, and noninvasive ventilation, all of which are associated with the development of subcutaneous emphysema, pneumomediastinum, and pneumothorax (herein collectively termed barotrauma).
To assess the occurrence rate of barotrauma in severe coronavirus disease 2019 and to explore possible associated factors.
A retrospective, single-center cohort study with nested case series, conducted at University Hospital Lewisham: a 450-bed general hospital in London, United Kingdom. All patients with confirmed coronavirus disease 2019 admitted to the critical care department from March 12, to April 12, 2020, were included.
Patients were retrospectively screened for radiological evidence of barotrauma. Admission characteristics, modalities of respiratory support, and outcomes were compared between barotrauma and nonbarotrauma groups. Respiratory parameters in the period preceding barotrauma identification were recorded.
Of 83 admissions with coronavirus disease 2019, eight suffered barotrauma (occurrence rate 9.6%; 95% CI 4.3%-18.1%). Barotrauma cases had longer illness duration prior to critical care admission (10 vs 7 d; interquartile range, 8-14 and 6-10, respectively; = 0.073) and were more often treated with continuous positive airway pressure or noninvasive ventilation as the initial modality of advanced respiratory support (87.5% vs 36.0%; = 0.007). Patients managed with continuous positive airway pressure or noninvasive ventilation prior to the development of barotrauma had median minute ventilation of 16.2-19.9 and 21.3-22.7 L/min, respectively. Compared with the nonbarotrauma group, a higher proportion of patients with barotrauma had died (62.5% vs 43.2%), and a lower proportion of patients had been discharged (25.0% vs 53.3%) at 3-month follow-up.
Barotrauma appears to be a common complication of severe coronavirus disease 2019. Determining whether high minute ventilation while using continuous positive airway pressure or noninvasive ventilation predisposes patients to barotrauma requires further investigation.
2019年严重冠状病毒病的管理依赖于先进的呼吸支持方式，包括有创机械通气、持续气道正压通气和无创通气，所有这些都与皮下气肿、纵隔气肿和气胸（在此统称为气压伤）的发生有关。
评估2019年严重冠状病毒病中气压伤的发生率，并探讨可能的相关因素。
设计、设置和参与者：一项回顾性单中心队列研究及嵌套病例系列研究，在刘易舍姆大学医院进行，该医院是英国伦敦一家拥有450张床位的综合医院。纳入了2020年3月12日至4月12日入住重症监护病房的所有确诊2019年冠状病毒病患者。
对患者进行回顾性筛查，以寻找气压伤的放射学证据。比较气压伤组和非气压伤组的入院特征、呼吸支持方式及结局。记录气压伤确诊前一段时间的呼吸参数。
在83例2019年冠状病毒病入院患者中，8例发生气压伤（发生率9.6%；95%CI 4.3%-18.1%）。气压伤病例在重症监护入院前的病程更长（分别为10天和7天；四分位间距分别为8-14天和6-10天；P=0.073），并且更常将持续气道正压通气或无创通气作为初始的高级呼吸支持方式（87.5%对36.0%；P=0.007）。在发生气压伤之前接受持续气道正压通气或无创通气治疗的患者，其分钟通气量中位数分别为16.2-19.9升/分钟和21.3-22.7升/分钟。与非气压伤组相比，气压伤患者死亡比例更高（62.5%对43.2%），在3个月随访时出院患者比例更低（25.0%对53.3%）。
气压伤似乎是2019年严重冠状病毒病的常见并发症。确定在使用持续气道正压通气或无创通气时高分钟通气量是否会使患者易患气压伤，需要进一步研究。
