Ventilatory associated barotrauma in COVID-19 patients: A multicenter observational case control study (COVI-MIX-study)

被引：31

作者：

Vetrugno, Luigi ^{[1
,2
,43
]}

Castaldo, Nadia ^{[3
]}

Fantin, Alberto ^{[3
]}

Deana, Cristian ^{[4
]}

Cortegiani, Andrea ^{[5
,6
]}

Longhini, Federico ^{[7
]}

Forfori, Francesco ^{[8
]}

Cammarota, Gianmaria ^{[9
,10
]}

Grieco, Domenico Luca ^{[11
,12
]}

Isola, Miriam ^{[13
]}

Navalesi, Paolo ^{[14
,15
]}

Maggiore, Salvatore Maurizio ^{[1
,16
]}

Bassetti, Matteo ^{[17
,18
]}

Chetta, Alfredo ^{[19
]}

Confalonieri, Marco ^{[20
,21
]}

De Martino, Maria ^{[13
]}

Ferrari, Giovanni ^{[22
]}

Francisi, Daniela ^{[23
]}

Luzzati, Roberto ^{[24
]}

Meini, Simone ^{[25
]}

Scozzafava, Mariano ^{[26
]}

Sozio, Emanuela ^{[27
]}

Tascini, Carlo ^{[27
]}

Bassi, Flavio ^{[4
]}

Patruno, Vincenzo ^{[3
]}

De Robertis, Edoardo ^{[9
,10
]}

Aldieri, Chiara ^{[28
]}

Ball, Lorenzo ^{[29
,30
]}

Baratella, Elisa ^{[20
]}

Bartoletti, Michele ^{[31
]}

Boscolo, Annalisa ^{[14
]}

Burgazzi, Barbara ^{[19
]}

Catalanotti, Vito ^{[31
]}

Confalonieri, Paola ^{[20
,21
]}

Corcione, Silvia ^{[32
]}

Rosa, Francesco Giuseppe De ^{[32
,33
]}

De Simoni, Alessandro ^{[19
]}

Del Bono, Valerio ^{[28
]}

Di Tria, Roberta ^{[22
]}

Forlani, Sara ^{[34
]}

Giacobbe, Daniele Roberto ^{[17
,18
]}

Granozzi, Bianca ^{[31
]}

Labate, Laura ^{[17
,18
]}

Lococo, Sara ^{[30
]}

Lupia, Tommaso ^{[33
]}

Matellon, Carola ^{[4
]}

Mehrabi, Sara ^{[35
]}

Morosi, Sabrina ^{[23
]}

Mongodi, Silvia ^{[36
]}

Mura, Maddalena ^{[25
]}

机构：

[1] SS Annunziata Hosp, Dept Anesthesiol Crit Care Med & Emergency, Chieti, Italy

[2] Univ G dAnnunzio, Dept Med Oral & Biotechnol Sci, Chieti, Italy

[3] Hlth Integrated Agcy Friuli Cent, Dept Cardiothorac Surg, Pulmonol Unit, Udine, Italy

[4] Hlth Integrated Agcy Friuli Cent, Dept Anesthesia & Intens Care, Udine, Italy

[5] Univ Palermo, Dept Surg Oncol & Oral Sci Di Chir On S, Palermo, Italy

[6] Policlin Paolo Giaccone, Dept Anesthesia Intens Care & Emergency, Palermo, Italy

[7] Magna Graecia Univ Catanzaro, Dept Med & Surg Sci, Catanzaro, Italy

[8] Univ Pisa, Dept Surg Med & Mol Pathol & Crit Care Med, AOUP, Pisa, Italy

[9] Univ Hosp Perugia, Anesthesia & Intens Care Serv 2, Perugia, Italy

[10] Univ Perugia, Dept Med & Surg, Perugia, Italy

[11] Univ Cattolica Sacro Cuore, Dept Anesthesiol & Intens Care Med, Rome, Italy

[12] Fdn Policlin Univ A Gemelli IRCCS, Dept Anesthesia Emergency & Intens Care Med, Rome, Italy

[13] Univ Udine, Dept Med, Udine, Italy

[14] Padua Univ Hosp, Inst Anaesthesia & Intens Care, Padua, Italy

[15] Univ Padua, Dept Med DIMED, Padua, Italy

[16] Gabriele Annunzio Univ Chieti Pescara, Dept Innovat Technol Med & Dent, Chieti, Italy

[17] Osped Policlin San Martino IRCCS, Infect Dis Unit, Genoa, Italy

[18] Univ Genoa, Dept Hlth Sci, Genoa, Italy

[19] Univ Parma, Dept Med & Surg, Resp Dis & Lung Funct Unit, Parma, Italy

[20] Univ Hosp Cattinara, Dept Pulmonol, Trieste, Italy

[21] Univ Trieste, Trieste, Italy

[22] AO Umberto I Mauriziano, Pneumol & Unita Terapia Semi Intensiva Respiratori, Turin, Italy

[23] Univ Perugia, Dept Infect Dis S Maria Misericordia Hosp, Perugia, Italy

[24] Univ Trieste, Infect Dis Unit, Trieste, Italy

[25] Felice Lotti Hosp, UO Med Interna, Azienda USL Toscana Nord Ovest, Pontedera, Italy

[26] Gen Hosp Lodi, Resp High Dependecy Unit, Lodi, Italy

[27] Hlth Integrated Agcy Friuli Cent, Infect Dis Div, Udine, Italy

[28] Hosp Santa Croce & Carle, Dept Med, Div Infect Dis, Cuneo, Italy

[29] Osped Policlin San Martino IRCCS, Anesthesia & Intens Care, Genoa, Italy

[30] Univ Genoa, Dept Surg Sci & Integrated Diagnost DISC, Genoa, Italy

[31] Policlin SantOrsola, Dept Med & Surg Sci, Infect Dis Unit, Bologna, Italy

[32] Univ Turin, Dept Med Sci, Infect Dis City Hlth & Sci, Turin, Italy

[33] Cardinal Massaia Hosp, Infect Dis Unit, Asti, Italy

[34] Lodi Gen Hosp, Pulm Med Unit, Lodi, Italy

[35] Univ Verona, Diagnost & Publ Hlth Dept, Infect Dis Div, Verona, Italy

[36] Fdn IRCCS Policlin San Matteo, Anaesthesia & Intens Care, Pavia, Italy

[37] Univ Bologna, Dept Clin Integrated & Expt Med DIMES, Bologna, Italy

[38] St Orsola Hosp, Resp & Crit Care Unit, Bologna, Italy

[39] AORN Ospedali Colli, UOC Malattie Infett ad Indirizzo Neurol, PO D Cotugno, Naples, Italy

[40] Santa Maria Angeli Hosp, Resp Dis Unit, Pordenone, Italy

[41] Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Padua, Italy

[42] Fdn Policlin Univ A Gemelli IRCCS, Dept Woman & Child Hlth & Publ Hlth, Rome, Italy

[43] Univ G dAnnunzio, Dept Med Oral & Biotechnol Sci, Via Vestini 33, I-66100 Chieti, Italy

来源：

PULMONOLOGY | 2023年 / 29卷 / 06期

关键词：

COVID-19; Acute respiratory failure; Barotrauma; Pneumothorax; High flow nasal cannula; Invasive mechanical ventilation; RISK-FACTORS; PNEUMOTHORAX; ARDS;

D O I：

10.1016/j.pulmoe.2022.11.002

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

Background: The risk of barotrauma associated with different types of ventilatory support is unclear in COVID-19 patients. The primary aim of this study was to evaluate the effect of the dif-ferent respiratory support strategies on barotrauma occurrence; we also sought to determine the frequency of barotrauma and the clinical characteristics of the patients who experienced this complication.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; other-wise 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).(c) 2022 Sociedade Portuguesa de Pneumologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

引用

页码：457 / 468

页数：12

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