Vetrugno Luigi, Deana Cristian, Castaldo Nadia, Fantin Alberto, Belletti Alessandro, Sozio Emanuela, De Martino Maria, Isola Miriam, Palumbo Diego, Longhini Federico, Cammarota Gianmaria, Spadaro Savino, Maggiore Salvatore Maurizio, Bassi Flavio, Tascini Carlo, Patruno Vincenzo
Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy.
Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100 Chieti, Italy.
J Clin Med. 2023 May 25;12(11):3675. doi: 10.3390/jcm12113675.
Noninvasive respiratory support (NIRS) has been extensively used during the COVID-19 surge for patients with acute respiratory failure. However, little data are available about barotrauma during NIRS in patients treated outside the intensive care unit (ICU) setting.
COVIMIX-2 was an ancillary analysis of the previous COVIMIX study, a large multicenter observational work investigating the frequencies of barotrauma (i.e., pneumothorax and pneumomediastinum) in adult patients with COVID-19 interstitial pneumonia. Only patients treated with NIRS outside the ICU were considered. Baseline characteristics, clinical and radiological disease severity, type of ventilatory support used, blood tests and mortality were recorded.
In all, 179 patients were included, 60 of them with barotrauma. They were older and had lower BMI than controls ( < 0.001 and = 0.045, respectively). Cases had higher respiratory rates and lower PaO/FiO ( = 0.009 and < 0.001). The frequency of barotrauma was 0.3% [0.1-1.3%], with older age being a risk factor for barotrauma (OR 1.06, = 0.015). Alveolar-arterial gradient (A-a) DO was protective against barotrauma (OR 0.92 [0.87-0.99], = 0.026). Barotrauma required active treatment, with drainage, in only a minority of cases. The type of NIRS was not explicitly related to the development of barotrauma. Still, an escalation of respiratory support from conventional oxygen therapy, high flow nasal cannula to noninvasive respiratory mask was predictive for in-hospital death (OR 15.51, = 0.001).
COVIMIX-2 showed a low frequency for barotrauma, around 0.3%. The type of NIRS used seems not to increase this risk. Patients with barotrauma were older, with more severe systemic disease, and showed increased mortality.
在新冠疫情高峰期，无创呼吸支持（NIRS）已被广泛应用于急性呼吸衰竭患者。然而，关于在重症监护病房（ICU）以外接受治疗的患者使用NIRS期间发生气压伤的数据却很少。
COVIMIX-2是对先前COVIMIX研究的一项辅助分析，COVIMIX研究是一项大型多中心观察性研究，调查了新冠病毒间质性肺炎成年患者的气压伤（即气胸和纵隔气肿）发生率。仅纳入在ICU以外接受NIRS治疗的患者。记录基线特征、临床和放射学疾病严重程度、使用的通气支持类型、血液检查结果及死亡率。
共纳入179例患者，其中60例发生气压伤。他们的年龄比对照组更大，体重指数更低（分别为P<0.001和P = 0.045）。病例组的呼吸频率更高，动脉血氧分压与吸入氧浓度比值更低（P = 0.009和P<0.001）。气压伤发生率为0.3%[0.1%-1.3%]，年龄较大是气压伤的一个危险因素（比值比1.06，P = 0.015）。肺泡-动脉血氧分压差（A-a）DO对气压伤有保护作用（比值比0.92[0.87-0.99]，P = 0.026）。气压伤仅在少数情况下需要积极治疗，如进行引流。NIRS的类型与气压伤的发生没有明确关联。然而，从传统氧疗、高流量鼻导管到无创呼吸面罩的呼吸支持升级是院内死亡的预测因素（比值比15.51，P = 0.001）。
COVIMIX-2研究显示气压伤发生率较低，约为0.3%。使用的NIRS类型似乎不会增加这种风险。发生气压伤的患者年龄较大，全身疾病更严重，且死亡率更高。
