Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
PLoS One. 2023 Mar 15;18(3):e0282868. doi: 10.1371/journal.pone.0282868. eCollection 2023.
Barotrauma frequently occurs in coronavirus disease 2019. Previous studies have reported barotrauma to be a mortality-risk factor; however, its time-dependent nature and pathophysiology are not elucidated. To investigate the time-dependent characteristics and the etiology of coronavirus disease 2019-related-barotrauma.
We retrospectively reviewed intubated patients with coronavirus disease 2019 from March 2020 to May 2021. We compared the 90-day survival between the barotrauma and non-barotrauma groups and performed landmark analyses on days 7, 14, 21, and 28. Barotrauma within seven days before the landmark was defined as the exposure. Additionally, we evaluated surgically treated cases of coronavirus disease 2019-related pneumothorax. We included 192 patients. Barotrauma developed in 44 patients (22.9%). The barotrauma group's 90-day survival rate was significantly worse (47.7% vs. 82.4%, p < 0.001). In the 7-day landmark analysis, there was no significant difference (75.0% vs. 75.7%, p = 0.79). Contrastingly, in the 14-, 21-, and 28-day landmark analyses, the barotrauma group's survival rates were significantly worse (14-day: 41.7% vs. 69.1%, p = 0.044; 21-day: 16.7% vs. 62.5%, p = 0.014; 28-day: 20.0% vs. 66.7%, p = 0.018). Pathological examination revealed a subpleural hematoma and pulmonary cyst with heterogenous lung inflammation.
Barotrauma was a poor prognostic factor for coronavirus disease 2019, especially in the late phase. Heterogenous inflammation may be a key finding in its mechanism. Barotrauma is a potentially important sign of lung destruction.
在 2019 年冠状病毒病（COVID-19）中经常发生气压伤。先前的研究报告气压伤是死亡风险因素；然而，其时间依赖性和病理生理学尚未阐明。为了研究 COVID-19 相关气压伤的时间依赖性特征和病因。
我们回顾性地研究了 2020 年 3 月至 2021 年 5 月期间插管的 COVID-19 患者。我们比较了气压伤组和非气压伤组 90 天的生存率，并在第 7、14、21 和 28 天进行了里程碑分析。在里程碑之前的 7 天内发生的气压伤被定义为暴露。此外，我们还评估了 COVID-19 相关气胸的手术治疗病例。我们纳入了 192 例患者。44 例（22.9%）发生气压伤。气压伤组的 90 天生存率显著较差（47.7% vs. 82.4%，p < 0.001）。在 7 天里程碑分析中，差异无统计学意义（75.0% vs. 75.7%，p = 0.79）。相反，在 14、21 和 28 天里程碑分析中，气压伤组的生存率显著较差（14 天：41.7% vs. 69.1%，p = 0.044；21 天：16.7% vs. 62.5%，p = 0.014；28 天：20.0% vs. 66.7%，p = 0.018）。病理检查显示，存在异质性肺炎症的胸膜下血肿和肺囊肿。
气压伤是 COVID-19 的预后不良因素，特别是在晚期。异质性炎症可能是其机制的关键发现。气压伤是肺破坏的一个潜在重要标志。
