Mahajan Varun, Kajal Kamal, Hazarika Amarjyoti, Singla Karan, Naik B Naveen, Ray Ananya, Ganesh Venkata, Singh Ajay, Bhalla Ashish, Puri Goverdhan Dutt
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Anaesthesia and Intensive Care, BR Ambedkar Institute of Medical Sciences, Mohali, Punjab, India *Email:
Qatar Med J. 2024 Dec 31;2024(4):64. doi: 10.5339/qmj.2024.64. eCollection 2024.
Pulmonary barotrauma in coronavirus disease-2019 (COVID-19) acute respiratory distress syndrome (ARDS) carries high risk of mortality. While various studies have reported increased mortality, few have assessed the contributing factors for the occurrence of this complication. This study aimed at exploring the contributing factors for barotrauma in COVID-19 ARDS.
In this retrospective study, patients aged ≥18 years with laboratory confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by reverse transcriptase polymerase chain reaction (RT-PCR) from a nasopharyngeal swab and having severe or critical COVID-19 disease requiring Intensive Care Unit (ICU) admission according to the World Health Organisation (WHO) criteria for disease severity in COVID-19 disease admitted at forty-bedded ICUs at a tertiary care research hospital in North India from April 1, 2020, to March 31, 2022 were included.
Of 825 patients admitted to COVID ICU, 40 developed pulmonary barotrauma, with a mortality rate of 85%. The mean ± SD PaO/FiO was 96.76 ± 27.78 mmHg. Thirty-nine patients received steroids, 37 developed secondary bacterial infection of the lower respiratory tract with one or more organisms. ( = 15), ( = 10), and ( = 8) were the commonest isolates. Ten patients developed pneumomediastinum, of which 6 patients had subcutaneous emphysema along with pneumomediastinum, and 2 patients developed isolated subcutaneous emphysema. The remaining 28 patients developed pneumothorax.The mean (±SD) for static respiratory system compliance (Crs) for patients on mechanical ventilation on the day of barotrauma was 19.3 (±10.5) mL/cmHO.
Patients with COVID-19 ARDS developing pulmonary barotrauma have a high associated mortality, and secondary bacterial infection, lung fragility, patient-ventilator asynchrony, as well as low respiratory system compliance, may contribute to lung injury, predisposing to barotrauma.
2019冠状病毒病（COVID-19）急性呼吸窘迫综合征（ARDS）中的肺气压伤具有很高的死亡风险。虽然各种研究报告了死亡率增加，但很少有研究评估这种并发症发生的促成因素。本研究旨在探讨COVID-19 ARDS中气压伤的促成因素。
在这项回顾性研究中，纳入了年龄≥18岁、通过鼻咽拭子逆转录聚合酶链反应（RT-PCR）实验室确诊为严重急性呼吸综合征冠状病毒2（SARS-CoV-2）、且根据世界卫生组织（WHO）的COVID-19疾病严重程度标准患有严重或危重型COVID-19疾病并需要入住重症监护病房（ICU）的患者，这些患者于2020年4月1日至2022年3月31日在印度北部一家三级护理研究医院的40张床位的ICU中住院。
在825名入住COVID ICU的患者中，40例发生了肺气压伤，死亡率为85%。平均±标准差的PaO/FiO为96.76±27.78 mmHg。39例患者接受了类固醇治疗，37例发生了下呼吸道继发细菌感染，感染一种或多种病原体。（=15）、（=10）和（=8）是最常见的分离株。10例患者发生纵隔气肿，其中6例患者除纵隔气肿外还伴有皮下气肿，2例患者发生孤立性皮下气肿。其余28例患者发生气胸。气压伤当天接受机械通气的患者静态呼吸系统顺应性（Crs）的平均值（±标准差）为19.3（±10.5）mL/cmH₂O。
发生肺气压伤的COVID-19 ARDS患者具有很高的相关死亡率，继发细菌感染、肺脆性、患者-呼吸机不同步以及低呼吸系统顺应性可能导致肺损伤，易引发气压伤。
