Journal of Clinical Medicine (Mar 2024)

Predictors of Mortality and Orotracheal Intubation in Patients with Pulmonary Barotrauma Due to COVID-19: An Italian Multicenter Observational Study during Two Years of the Pandemic

  • Nardi Tetaj,
  • Gennaro De Pascale,
  • Massimo Antonelli,
  • Joel Vargas,
  • Martina Savino,
  • Francesco Pugliese,
  • Francesco Alessandri,
  • Giovanni Giordano,
  • Pierfrancesco Tozzi,
  • Monica Rocco,
  • Anna Maria Biava,
  • Luigi Maggi,
  • Raffaella Pisapia,
  • Francesco Maria Fusco,
  • Giulia Valeria Stazi,
  • Gabriele Garotto,
  • Maria Cristina Marini,
  • Pierluca Piselli,
  • Alessia Beccacece,
  • Andrea Mariano,
  • Maria Letizia Giancola,
  • Stefania Ianniello,
  • Francesco Vaia,
  • Enrico Girardi,
  • Andrea Antinori,
  • Maria Grazia Bocci,
  • Luisa Marchioni,
  • Emanuele Nicastri

DOI
https://doi.org/10.3390/jcm13061707
Journal volume & issue
Vol. 13, no. 6
p. 1707

Abstract

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Introduction: Coronavirus disease 2019 (COVID-19) is a significant and novel cause of acute respiratory distress syndrome (ARDS). During the COVID-19 pandemic, there has been an increase in the incidence of cases involving pneumothorax and pneumomediastinum. However, the risk factors associated with poor outcomes in these patients remain unclear. Methods: This observational study collected clinical and imaging data from COVID-19 patients with PTX and/or PNM across five tertiary hospitals in central Italy between 1 March 2020 and 1 March 2022. This study also calculated the incidence of PTX and PNM and utilized multivariable regression analysis and Kaplan–Meier curve analysis to identify predictor factors for 28-day mortality and 3-day orotracheal intubation after PTX/PNM. This study also considered the impact of the three main variants of concern (VoCs) (alfa, delta, and omicron) circulating during the study period. Results: During the study period, a total of 11,938 patients with COVID-19 were admitted. This study found several factors independently associated with a higher risk of death in COVID-19 patients within 28 days of pulmonary barotrauma. These factors included a SOFA score ≥ 4 (OR 3.22, p = 0.013), vasopressor/inotropic therapy (OR 11.8, p p = 0.021), PaO2/FiO2 ratio p p p = 0.015), PCO2 > 45 mmHg (OR 6.0, p = 0.003), and P/F ratio p Conclusions: This study suggests that a high SOFA score (≥4), the need for vasopressor/inotropic therapy, hypercapnia, and PaO2/FiO2 ratio < 150 mmHg in COVID-19 patients with pulmonary barotrauma are associated with higher rates of intubation, ICU admission, and mortality. Identifying these risk factors early on can help healthcare providers anticipate and manage these patients more effectively and provide timely interventions with appropriate intensive care, ultimately improving their outcomes.

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