Bajto Petra, Saric Ivana, Bugarin Josipa Domazet, Delic Nikola, Dosenovic Svjetlana, Ilic Darko, Stipic Sanda Stojanovic, Duplancic Bozidar, Saric Lenko
Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Split, Croatia.
J Thorac Dis. 2023 Oct 31;15(10):5297-5306. doi: 10.21037/jtd-23-677. Epub 2023 Sep 22.
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Although it is known that the COVID-19 acute respiratory distress syndrome (ARDS) is associated with higher incidence of pulmonary barotrauma, unique mechanisms causing the aforementioned complication are still to be investigated. The goal of this research was to investigate the incidence of barotrauma among COVID-19 patients treated in the intensive care unit (ICU) and to examine different clinical outcomes among those subjects.
This retrospective observational cohort study included adult COVID-19 patients admitted to ICU from September 1, 2020, to February 28, 2022. All admitted subjects received invasive respiratory support. Subjects were divided into two groups based on occurrence of pulmonary barotrauma. Data were collected from available electronical medical records.
In the study period, a total of 900 subjects met inclusion criteria. Pulmonary barotrauma occurred in 88 (9.8%) of them. Subcutaneous emphysema developed in 73 (83%), pneumomediastinum in 68 (77.3%) and pneumothorax in 54 (61.4%) subjects. A small group of subjects developed less common complications like pneumoperitoneum (8 subjects, 9.1%) and pneumopericardium (2 subjects, 2.3%). Survival rate was higher in control than in barotrauma group [396 (48.8%) 22 (25.0%), P<0.05]. There was also a significant difference between two groups in PaO/FiO ratio on admission, duration of non-invasive respiratory support before mechanical ventilation, duration of mechanical ventilation and duration of ICU and hospital stay, all in favour of control group.
Development of barotrauma in patients with severe forms of COVID-19 disease and in need of respiratory support is associated with longer ICU and hospital stay as well as lower survival rates at hospital discharge. Further efforts are needed in understanding mechanism in developing barotrauma and finding new prevention and treatment options.
2019冠状病毒病（COVID-19）是由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的一种传染病。虽然已知COVID-19急性呼吸窘迫综合征（ARDS）与肺气压伤的较高发生率相关，但导致上述并发症的独特机制仍有待研究。本研究的目的是调查在重症监护病房（ICU）接受治疗的COVID-19患者中气压伤的发生率，并检查这些受试者的不同临床结局。
这项回顾性观察性队列研究纳入了2020年9月1日至2022年2月28日入住ICU的成年COVID-19患者。所有入院受试者均接受有创呼吸支持。根据肺气压伤的发生情况将受试者分为两组。数据从可用的电子病历中收集。
在研究期间，共有900名受试者符合纳入标准。其中88例（9.8%）发生了肺气压伤。73例（83%）出现皮下气肿，68例（77.3%）出现纵隔气肿，54例（61.4%）出现气胸。一小部分受试者出现了不太常见的并发症，如气腹（8例，9.1%）和心包积气（2例，2.3%）。对照组的生存率高于气压伤组[396例（48.8%）对22例（25.0%），P<0.05]。两组在入院时的PaO/FiO比值、机械通气前无创呼吸支持的持续时间、机械通气的持续时间以及ICU和住院时间方面也存在显著差异，所有这些均有利于对照组。
患有严重COVID-19疾病且需要呼吸支持的患者发生气压伤与更长的ICU和住院时间以及出院时较低的生存率相关。需要进一步努力了解气压伤的发生机制并寻找新的预防和治疗方法。
