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

Vetrugno, L.; Castaldo, N.; Fantin, A.; Deana, C.; Cortegiani, A.; Longhini, F.; Forfori, F.; Cammarota, G.; Grieco, D. L.; Isola, M.; Navalesi, P.; Maggiore, S. M.; Bassetti, M.; Chetta, A.; Confalonieri, M.; De Martino, M.; Ferrari, G.; Francisi, D.; Luzzati, R.; Meini, S.; Scozzafava, M.; Sozio, E.; Tascini, C.; Bassi, F.; Patruno, V.; De Robertis, E.; Aldieri, C.; Ball, L.; Baratella, E.; Bartoletti, M.; Boscolo, A.; Burgazzi, B.; Catalanotti, V.; Confalonieri, P.; Corcione, S.; De Rosa, F. G.; De Simoni, A.; Bono, V. D.; Tria, R. D.; Forlani, S.; Giacobbe, D. R.; Granozzi, B.; Labate, L.; Lococo, S.; Lupia, T.; Matellon, C.; Mehrabi, S.; Morosi, S.; Mongodi, S.; Mura, M.; Nava, S.; Pol, R.; Pettenuzzo, T.; Quyen, N. H.; Rescigno, C.; Righi, E.; Ruaro, B.; Salton, F.; Scabini, S.; Scarda, A.; Sibani, M.; Tacconelli, E.; Tartaglione, G.; Tazza, B.; Vania, E.; Viale, P.; Vianello, A.; Visentin, A.; Zuccon, U.; Meroi, F.; Buonsenso, D.

doi:10.1016/j.pulmoe.2022.11.002

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 different 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; 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).