Ventilatory associated barotrauma in COVID-19 patients: A multicenter observational case control study (COVI-MIX-study).
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Vetrugno Luigi, Castaldo Nadia, Fantin Alberto, Deana Cristian, Cortegiani Andrea, Longhini Federico, Forfori Francesco, Cammarota Gianmaria, Grieco Domenico Luca, Isola Miriam, Navalesi Paolo, Maggiore Salvatore Maurizio, Bassetti Matteo, Chetta Alfredo, Confalonieri Marco, De Martino Maria, Ferrari Giovanni, Francisi Daniela, Luzzati Roberto, Meini Simone, Scozzafava Mariano, Sozio Emanuela, Tascini Carlo, Bassi Flavio, Patruno Vincenzo, Italian COVI-MIX Study Group, De Robertis Edoardo, Aldieri Chiara, Ball Lorenzo, Baratella Elisa, Bartoletti Michele, Boscolo Annalisa, Burgazzi Barbara, Catalanotti Vito, Confalonieri Paola, Corcione Silvia, De Rosa Francesco Giuseppe, De Simoni Alessandro, Bono Valerio Del, Tria Roberta Di, Forlani Sara, Giacobbe Daniele Roberto, Granozzi Bianca, Labate Laura, Lococo Sara, Lupia Tommaso, Matellon Carola, Mehrabi Sara, Morosi Sabrina, Mongodi Silvia, Mura Maddalena, Nava Stefano, Pol Riccardo, Pettenuzzo Tommaso, Quyen Nguyen Hoang, Rescigno Carolina, Righi Elda, Ruaro Barbara, Salton Francesco, Scabini Silvia, Scarda Angelo, Sibani Marcella, Tacconelli Evelina, Tartaglione Gennaro, Tazza Beatrice, Vania Eleonora, Viale Pierluigi, Vianello Andrea, Visentin Alessandro, Zuccon Umberto, Meroi Francesco, Buonsenso Danilo
Аннотация
METHODS: This multicentre retrospective case-control study from 1 March 2020 to 28 February 2021 included COVID-19 patients who experienced barotrauma during hospital stay. They were matched with controls in a 1:1 ratio for the same admission period in the same ward of treatment. Univariable and multivariable logistic regression (OR) were performed to explore which factors were associated with barotrauma and in-hospital death.
RESULTS: We included 200 cases and 200 controls. Invasive mechanical ventilation was used in 39.3% of patients in the barotrauma group, and in 20.1% of controls (p<0.001). Receiving non-invasive ventilation (C-PAP/PSV) instead of conventional oxygen therapy (COT) increased the risk of barotrauma (OR 5.04, 95% CI 2.30 - 11.08, p<0.001), similarly for invasive mechanical ventilation (OR 6.24, 95% CI 2.86-13.60, p<0.001). High Flow Nasal Oxygen (HFNO), compared with COT, did not significantly increase the risk of barotrauma. Barotrauma frequency occurred in 1.00% [95% CI 0.88-1.16] of patients; these were older (p=0.022) and more frequently immunosuppressed (p=0.013). Barotrauma was shown to be an independent risk for death (OR 5.32, 95% CI 2.82-10.03, p<0.001).
CONCLUSIONS: C-PAP/PSV compared with COT or HFNO increased the risk of barotrauma; otherwise HFNO did not. Barotrauma was recorded in 1.00% of patients, affecting mainly patients with more severe COVID-19 disease. Barotrauma was independently associated with mortality.
TRIAL REGISTRATION: this case-control study was prospectively registered in clinicaltrial.gov as NCT04897152 (on 21 May 2021).