Büyükkarabacak Yasemin, Pirzirenli Mehmet Gökhan, Gurz Selçuk, Abacı Hasan, Taslak Şengül Ayşen, Çelik Burçin, Basoğlu Ahmet
Department of Thoracic Surgery, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye.
Biometrics and Genetics Unit, Ondokuz Mayıs University Faculty of Agriculture, Samsun, Türkiye.
Turk Gogus Kalp Damar Cerrahisi Derg. 2023 Jan 30;31(1):69-77. doi: 10.5606/tgkdc.dergisi.2023.23081. eCollection 2023 Jan.
In this study, we aimed to analyze the risk factors of barotrauma in patients who were followed in the intensive care unit due to novel coronavirus disease 2019 (COVID-19) pneumonia.
Between March 2020 and January 2021, a total of 261 patients (155 males, 106 females; mean age: 63.3±15.3 years; range, 11 to 91 years) who were followed in the intensive care unit due to COVID-19 pneumonia and were diagnosed with pneumothorax, pneumomediastinum, and subcutaneous emphysema were retrospectively analyzed. Demographics data of the patients, past and current medical history, clinical management, patient progress, and survival data were obtained from medical records of our hospital.
Twenty-seven of the patients were diagnosed with barotrauma. A total of 88.8% of the patients were followed with intubation. The development of pneumothorax, pneumomediastinum, and subcutaneous emphysema due to barotrauma was not dependent on sex, smoking/non-smoking status, using/not using corticosteroids, or comorbid diseases. There was a significant correlation between pneumothorax, pneumomediastinum, and subcutaneous emphysema development in intubated patients with different ventilator modes. Changing the ventilator mode from synchronized intermittent mandatory ventilation to airway pressure release ventilation increased the possibility of barotrauma by 15 times.
Despite all lung-protective applications, barotrauma is a common complication, particularly in mechanically ventilated patients who have COVID-19 pneumonia with severe acute respiratory distress syndrome. Mechanical ventilator pressure modes should be patientspecific and followed carefully and frequently for the risk of barotrauma.
在本研究中，我们旨在分析因2019年新型冠状病毒病（COVID-19）肺炎而在重症监护病房接受治疗的患者发生气压伤的危险因素。
回顾性分析2020年3月至2021年1月期间，因COVID-19肺炎在重症监护病房接受治疗且被诊断为气胸、纵隔气肿和皮下气肿的261例患者（155例男性，106例女性；平均年龄：63.3±15.3岁；范围为11至91岁）。从我院病历中获取患者的人口统计学数据、既往和当前病史、临床管理、患者病情进展及生存数据。
27例患者被诊断为气压伤。共有88.8%的患者接受了插管治疗。气压伤导致的气胸、纵隔气肿和皮下气肿的发生与性别、吸烟/非吸烟状态、使用/未使用皮质类固醇或合并疾病无关。在使用不同通气模式的插管患者中，气胸、纵隔气肿和皮下气肿的发生之间存在显著相关性。将通气模式从同步间歇强制通气改为气道压力释放通气会使气压伤的可能性增加15倍。
尽管采取了所有肺保护措施，但气压伤仍是一种常见并发症，尤其是在患有严重急性呼吸窘迫综合征的COVID-19肺炎机械通气患者中。机械通气压力模式应因人而异，并应仔细且频繁地监测气压伤风险。
