Characteristics and outcomes of pulmonary barotrauma in patients with COVID-19 ARDS: A retrospective observational study

Introduction: 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.

Methodology: 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.

Results: Of 825 patients admitted to COVID ICU, 40 developed pulmonary barotrauma, with a mortality rate of 85%. The mean ± SD PaO2/FiO2 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. Acinetobacter baumannii (n = 15), Klebsiella pneumoniae (n = 10), and Pseudomonas aeruginosa (n = 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/cmH2O.

Conclusion: 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.