Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul -Porto Alegre (RS), Brazil.
Hospital Divina Providência - Porto Alegre (RS), Brazil.
Crit Care Sci. 2024 Aug 30;36:e20240248en. doi: 10.62675/2965-2774.20240248-en. eCollection 2024.
To evaluate how ventilatory support, the duration of invasive ventilatory support use and lung mechanics are related to barotrauma development in patients who are severely infected with COVID-19 and who are admitted to the intensive care unit and develop pulmonary barotrauma.
Retrospective cohort study of patients who were severely infected with COVID-19 and who developed pulmonary barotrauma secondary to mechanical ventilation.
This study included 60 patients with lung barotrauma who were divided into two groups: 37 with early barotrauma and 23 with late barotrauma. The early barotrauma group included more individuals who needed noninvasive ventilation (62.2% versus 26.1%, p = 0.01). The tidal volume/kg of predicted body weight on the day of barotrauma was measured, and 24 hours later, it was significantly greater in the late barotrauma group than in the early barotrauma group. During the day, barotrauma was accompanied by plateau pressure and driving pressure accompanied by tidal volume, which significantly increased in the late barotrauma group. According to the SAPS 3, patients in the early barotrauma group had more pulmonary thromboembolism and more severe illness. However, the intensive care unit mortality rates did not significantly differ between the two groups (66.7% for early barotrauma versus 76.9% for late barotrauma).
We investigated the effect of respiratory mechanics on barotrauma in patients with severe COVID-19 and found that 25% of patients were on nonprotective ventilation parameters when they developed barotrauma. However, 50% of patients were on protective ventilation parameters, suggesting that other nonventilatory factors may contribute to barotrauma.
评估严重感染 COVID-19 并入住重症监护病房且发生肺气压伤的患者，其通气支持、有创通气支持的使用时间和肺力学与气压伤发展之间的关系。
对继发于机械通气的 COVID-19 严重感染并发肺气压伤的患者进行回顾性队列研究。
本研究纳入 60 例肺气压伤患者，分为两组：早期气压伤组 37 例，晚期气压伤组 23 例。早期气压伤组中需要无创通气的患者更多（62.2%比 26.1%，p=0.01）。气压伤当天测量了潮气量/kg 预计体重，24 小时后，晚期气压伤组明显大于早期气压伤组。在白天，气压伤伴随着平台压和驱动压伴随着潮气量，晚期气压伤组明显增加。根据 SAPS 3，早期气压伤组患者有更多的肺血栓栓塞症和更严重的疾病。然而，两组的重症监护病房死亡率无显著差异（早期气压伤组为 66.7%，晚期气压伤组为 76.9%）。
我们研究了严重 COVID-19 患者呼吸力学对气压伤的影响，发现发生气压伤时，25%的患者通气参数无保护作用。然而，50%的患者通气参数具有保护作用，提示其他非通气因素可能导致气压伤。
