Hamouri Shadi, Samrah Shaher M, Albawaih Omar, Saleh Zidan, Smadi Mahmoud M, Alhazymeh Ahmad, Syaj Sebawe
Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, 22110, Jordan.
Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, 22110, Jordan.
Int J Gen Med. 2021 May 24;14:2017-2032. doi: 10.2147/IJGM.S314155. eCollection 2021.
This study aims to determine the incidence and outcome of COVID-19 patients who required positive pressure ventilation (PPV) and subsequently developed pulmonary barotrauma (PBT). Also, to investigate the risk factors and predictors of these complications to better understand the disease pathogenesis.
This retrospective analysis enrolled all adult COVID-19 patients admitted through the period from October 1, 2020, to December 31, 2020. All patients who received any form of PPV were included. Patients were then divided into two groups based on PBT development, including subcutaneous emphysema, pneumothorax, and pneumomediastinum. Medical records of all patients were reviewed. Patients' demographics, laboratory data on admission, respiratory support modes, surgical interventions, and outcomes were collected and analyzed.
In the specified period, 1095 patients were hospitalized due to COVID-19 illness. A total of 239 (21.8%) of all admitted patients received PPV. PBT accounted for 21.3% (51/239) of the study cohort. While both groups were equally exposed to the same modes of PPV, receiving invasive ventilation significantly correlated with decreased PBT odds (OR = 0.891; 95% CI, 0.803-0.988; =0.029). PBT patients were significantly younger (<0.001). Diabetes mellitus was found to have a protective effect on developing PBT (OR = 0.867; 95% CI, 0.782-0.962), while PO/FIO ratio was inversely associated with higher odds of developing PBT in both univariate and multivariate analyses (=0.03 and =0.019, respectively).
COVID-19-infected patients are at a higher risk of developing PBT. Invasive positive pressure ventilation was associated with less PBT compared to noninvasive ventilation and delaying intubation does not seem to reduce the risk of pulmonary barotrauma.
本研究旨在确定需要正压通气（PPV）并随后发生肺气压伤（PBT）的新冠病毒疾病（COVID-19）患者的发病率及预后情况。同时，调查这些并发症的危险因素及预测因素，以更好地理解疾病发病机制。
本回顾性分析纳入了2020年10月1日至2020年12月31日期间收治的所有成年COVID-19患者。纳入所有接受任何形式PPV的患者。然后根据是否发生PBT将患者分为两组，PBT包括皮下气肿、气胸和纵隔气肿。对所有患者的病历进行了回顾。收集并分析患者的人口统计学资料、入院时的实验室数据、呼吸支持模式、手术干预措施及预后情况。
在特定时期，1095例患者因COVID-19疾病住院。所有入院患者中共有239例（21.8%）接受了PPV。PBT占研究队列的21.3%（51/239）。虽然两组接受相同模式的PPV的情况相同，但接受有创通气与PBT发生几率降低显著相关（OR = 0.891；95%CI，0.803 - 0.988；P = 0.029）。发生PBT的患者明显更年轻（P<0.001）。发现糖尿病对发生PBT有保护作用（OR = 0.867；95%CI，0.782 - 0.962），而在单因素和多因素分析中，氧合指数（PO/FIO₂）与发生PBT的较高几率呈负相关（分别为P = 0.03和P = 0.019）。
感染COVID-19的患者发生PBT的风险较高。与无创通气相比，有创正压通气与较少的PBT相关，且延迟插管似乎并不能降低肺气压伤的风险。
