Pulmonary barotrauma in COVID-19 patients: Experience from a tertiary university hospital

Introduction: Mechanical ventilation (MV) in COVID-19 patients is often complicated with pulmonary barotrauma. The aim of this study was to determine the incidence and risk factors associated with the development of pulmonary barotrauma in mechanically ventilated COVID-19 patients. Materials and methods: We included all mechanically ventilated COVID-19 patients who were aged 18 and above whom admitted to COVID ICU between January 2021 and June 2022. Patients who developed pulmonary barotrauma prior to or within 24 hours of ICU admission, iatrogenic pneumothorax, readmitted to ICU and ventilated for other causes than respiratory failure due to COVID-19 were excluded. The data for demographic, vaccination status, ventilator settings, laboratory data, steroid and immunomodulator therapies received were analysed. Univariate and multivariate analysis were carried out to determine the risk factors and outcome. Results: Medical records of 204 patients were included. The incidence of pulmonary barotrauma was 22.5%. Lower C-reactive protein (CRP) value on admission to ICU and FiO2 prescription in the first week of MV, utilisation of higher PEEP in the second week of MV and longer ventilator days predisposed patients to pulmonary barotrauma (p = 0.039, p = 0.049, p = 0.021, p = 0.036 respectively). Pulmonary barotrauma increased the duration of ICU stay (p = 0.006) and all-cause ICU mortality (p = 0.009). Conclusion: Lower level of CRP and FiO2 prescription, higher use of PEEP and longer ventilator days were the independent risk factors in our study population to develop pulmonary barotrauma which increased their duration of ICU stay and all-cause ICU mortality.