High Incidence of Barotrauma in Patients with COVID-19 Infection on Invasive Mechanical Ventilation

McGuinness, Georgeann; Zhan, Chenyang; Rosenberg, Noah; Azour, Lea; Wickstrom, Maj; Mason, Derek M.; Thomas, Kristen M.; Moore, William H.

BACKGROUND: We observed a high number of patients with COVID-19 pneumonia who had barotrauma related to invasive mechanical ventilation at our institution. PURPOSE: To determine if the rate of barotrauma in patients with COVID-19 infection was greater than other patients requiring invasive mechanical ventilation at our institution. METHODS: In this retrospective study, clinical and imaging data of patients seen between 03/01/2020 and 04/06/2020 who tested positive for COVID-19 and experienced barotrauma associated with invasive mechanical ventilation were compared to patients without COVID-19 infection during the same period. Historical comparison was made to barotrauma rates of patients with acute respiratory distress syndrome (ARDS) from 02/01/2016 to 02/01/2020 at our institution. Comparison of patient groups was performed using categorical or continuous statistical testing as appropriate with multivariable regression analysis. Patient survival was assessed using Kaplan-Meier curves analysis. RESULTS: 601 patients with COVID-19 infection underwent invasive mechanical ventilation (63 ± 15 years, 71% men). There were 89/601 (15%) patients with one or more barotrauma events, for a total of 145 barotrauma events (24% overall events) (95% CI 21-28%). During the same period, 196 patients without COVID-19 infection (64 ± 19 years, 52% male) with invasive mechanical ventilation had 1 barotrauma event (.5% 95% CI, 0-3%, p<.001 vs. the group with COVID-19 infection). Of 285 patients with ARDS over the prior 4 years on invasive mechanical ventilation (68 ± 17 years, 60% men), 28 patients (10%) had 31 barotrauma events, with overall barotrauma rate of 11% (95% CI 8-15%, p<.001 vs. the group with COVID-19 infection). Barotrauma is an independent risk factor for death in COVID-19 (OR=2.2, p=.03), and is associated with longer hospital length of stay (OR=.92, p<.001). CONCLUSION: Patients with COVID-19 infection and invasive mechanical ventilation had a higher rate of barotrauma than patients with ARDS and patients without COVID-19 infection.