Barotrauma in mechanically-ventilated patients with coronavirus disease 2019: a survey of 38 hospitals in Lombardy, Italy.

Protti, Alessandro; Greco, Massimiliano; Filippini, Matteo; Vilardo, Anna Maria; Langer, Thomas; Tavola, Mario; Frutos-Vivar, Fernando; Santini, Alessandro; Caruso, Pier Francesco; Spano, Sofia; Anzueto, Antonio; Citerio, Giuseppe; Bellani, Giacomo; Foti, Giuseppe; Fumagalli, Roberto; Pesenti, Antonio; Grasselli, Giacomo; Cecconi, Maurizio

BACKGROUND The aim was to describe the incidence and risk factors of barotrauma in patients with the coronavirus disease 2019 (COVID-19) on invasive mechanical ventilation, during the outbreak in our region (Lombardy, Italy). METHODS The study was an electronic survey open from March 27th to May 2nd, 2020. Patients with COVID-19 who developed barotrauma while on invasive mechanical ventilation from 61 hospitals of the COVID-19 Lombardy Intensive Care Unit Network were involved. RESULTS The response rate was 38/61 (62%). The incidence of barotrauma was 145/2041 (7.1%; 95%-CI: 6.1-8.3%). Only a few cases occurred with ventilatory settings that may be considered non-protective such as a plateau airway pressure >35 cmH2O (2/113 [2%]), a driving airway pressure >15 cmH2O (30/113 [27%]), or a tidal volume >8 ml/kg of ideal body weight and a plateau airway pressure >30 cmH2O (12/134 [9%]). CONCLUSIONS within the limits of a survey, patients with COVID-19 might be at high risk for barotrauma during invasive (and allegedly lung-protective) mechanical ventilation.