Pulmonology (Nov 2023)
Ventilatory associated barotrauma in COVID-19 patients: A multicenter observational case control study (COVI-MIX-study)
- Luigi Vetrugno,
- Nadia Castaldo,
- Alberto Fantin,
- Cristian Deana,
- Andrea Cortegiani,
- Federico Longhini,
- Francesco Forfori,
- Gianmaria Cammarota,
- Domenico Luca Grieco,
- Miriam Isola,
- Paolo Navalesi,
- Salvatore Maurizio Maggiore,
- Matteo Bassetti,
- Alfredo Chetta,
- Marco Confalonieri,
- Maria De Martino,
- Giovanni Ferrari,
- Daniela Francisi,
- Roberto Luzzati,
- Simone Meini,
- Mariano Scozzafava,
- Emanuela Sozio,
- Carlo Tascini,
- Flavio Bassi,
- Vincenzo Patruno,
- Edoardo De Robertis,
- Chiara Aldieri,
- Lorenzo Ball,
- Elisa Baratella,
- Michele Bartoletti,
- Annalisa Boscolo,
- Barbara Burgazzi,
- Vito Catalanotti,
- Paola Confalonieri,
- Silvia Corcione,
- Francesco Giuseppe De Rosa,
- Alessandro De Simoni,
- Valerio Del Bono,
- Roberta Di Tria,
- Sara Forlani,
- Daniele Roberto Giacobbe,
- Bianca Granozzi,
- Laura Labate,
- Sara Lococo,
- Tommaso Lupia,
- Carola Matellon,
- Sara Mehrabi,
- Sabrina Morosi,
- Silvia Mongodi,
- Maddalena Mura,
- Stefano Nava,
- Riccardo Pol,
- Tommaso Pettenuzzo,
- Nguyen Hoang Quyen,
- Carolina Rescigno,
- Elda Righi,
- Barbara Ruaro,
- Francesco Salton,
- Silvia Scabini,
- Angelo Scarda,
- Marcella Sibani,
- Evelina Tacconelli,
- Gennaro Tartaglione,
- Beatrice Tazza,
- Eleonora Vania,
- Pierluigi Viale,
- Andrea Vianello,
- Alessandro Visentin,
- Umberto Zuccon,
- Francesco Meroi,
- Danilo Buonsenso
Affiliations
- Luigi Vetrugno
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
- Nadia Castaldo
- Department of Cardiothoracic Surgery, Pulmonology Unit, Health Integrated Agency of Friuli Centrale, Udine, Italy
- Alberto Fantin
- Department of Cardiothoracic Surgery, Pulmonology Unit, Health Integrated Agency of Friuli Centrale, Udine, Italy
- Cristian Deana
- Department of Anesthesia and Intensive Care., Health Integrated Agency of Friuli Centrale, Udine, Italy
- Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Federico Longhini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Francesco Forfori
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, AOUP-Pisa, Italy
- Gianmaria Cammarota
- University Hospital of Perugia., S. Andrea delle Fratte, Perugia, Italy
- Domenico Luca Grieco
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy
- Miriam Isola
- Department of Medicine., University of Udine, Udine, Italy
- Paolo Navalesi
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy
- Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
- Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
- Alfredo Chetta
- Respiratory Disease and Lung Function Unit., Department of Medicine and Surgery, University of Parma, Parma, Italy
- Marco Confalonieri
- Department of Pulmonology., University Hospital of Cattinara, Trieste, Italy
- Maria De Martino
- Department of Medicine., University of Udine, Udine, Italy
- Giovanni Ferrari
- Infectious Disease Unit, University Hospital of Trieste, Trieste, Italy
- Daniela Francisi
- U.O. Medicina Interna, Felice Lotti Hospital, Azienda USL Toscana Nord-Ovest, Pontedera, Italy
- Roberto Luzzati
- Respiratory High Dependency Unit - General Hospital Lodi, Lodi, Italy
- Simone Meini
- Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy
- Mariano Scozzafava
- Respiratory High Dependecy Unit - General Hospital Lodi, Lodi, Italy
- Emanuela Sozio
- Anesthesia and Intensive Care, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
- Carlo Tascini
- Department of Medicine., University of Udine, Udine, Italy
- Flavio Bassi
- Department of Anesthesia and Intensive Care., Health Integrated Agency of Friuli Centrale, Udine, Italy
- Vincenzo Patruno
- Department of Cardiothoracic Surgery, Pulmonology Unit, Health Integrated Agency of Friuli Centrale, Udine, Italy
- Edoardo De Robertis
- University Hospital of Perugia., S. Andrea delle Fratte, Perugia, Italy
- Chiara Aldieri
- Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
- Lorenzo Ball
- Anesthesia and Intensive Care, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
- Elisa Baratella
- Department of Pulmonology., University Hospital of Cattinara, Trieste, Italy
- Michele Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
- Annalisa Boscolo
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy
- Barbara Burgazzi
- Respiratory Disease and Lung Function Unit., Department of Medicine and Surgery, University of Parma, Parma, Italy
- Vito Catalanotti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
- Paola Confalonieri
- Department of Pulmonology., University Hospital of Cattinara, Trieste, Italy
- Silvia Corcione
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
- Francesco Giuseppe De Rosa
- Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy
- Alessandro De Simoni
- Respiratory Disease and Lung Function Unit., Department of Medicine and Surgery, University of Parma, Parma, Italy
- Valerio Del Bono
- Division of Infectious Diseases, Department of Medicine, Hospital Santa Croce e Carle, Cuneo, Italy
- Roberta Di Tria
- Infectious Disease Unit, University Hospital of Trieste, Trieste, Italy
- Sara Forlani
- Pulmonary Medicine Unit, Lodi General Hospital, Lodi, Italy
- Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
- Bianca Granozzi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
- Laura Labate
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
- Sara Lococo
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Tommaso Lupia
- Infectious Diseases Unit, Cardinal Massaia Hospital, Asti, Italy
- Carola Matellon
- Department of Anesthesia and Intensive Care., Health Integrated Agency of Friuli Centrale, Udine, Italy
- Sara Mehrabi
- Infectious Diseases Division, Diagnostics and Public Health Department, University of Verona, Verona, Italy
- Sabrina Morosi
- U.O. Medicina Interna, Felice Lotti Hospital, Azienda USL Toscana Nord-Ovest, Pontedera, Italy
- Silvia Mongodi
- Anaesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Maddalena Mura
- Infectious Diseases Division, Health Integrated Agency of Friuli Centrale, Udine, Italy
- Stefano Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), University of Bologna, Bologna, Italy
- Riccardo Pol
- Respiratory High Dependency Unit - General Hospital Lodi, Lodi, Italy
- Tommaso Pettenuzzo
- Institute of Anaesthesia and Intensive Care, Padua University Hospital, Padua, Italy
- Nguyen Hoang Quyen
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Carolina Rescigno
- UOC Malattie Infettive ad Indirizzo Neurologico, AORN Ospedali dei Colli, P.O. "D. Cotugno", Naples, Italy
- Elda Righi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Barbara Ruaro
- Department of Pulmonology., University Hospital of Cattinara, Trieste, Italy
- Francesco Salton
- Department of Pulmonology., University Hospital of Cattinara, Trieste, Italy
- Silvia Scabini
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
- Angelo Scarda
- Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy
- Marcella Sibani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Evelina Tacconelli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Gennaro Tartaglione
- Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy
- Beatrice Tazza
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
- Eleonora Vania
- Anesthesia and Intensive Care, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
- Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
- Andrea Vianello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Alessandro Visentin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Umberto Zuccon
- Respiratory Disease Unit, "Santa Maria degli Angeli" Hospital, Pordenone, Italy
- Francesco Meroi
- Department of Medicine., University of Udine, Udine, Italy
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- DOI
- https://doi.org/10.1016/j.pulmoe.2022.11.002
- Journal volume & issue
-
Vol. 29,
no. 6
pp. 457 – 468
Abstract
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).
Keywords
- COVID-19
- Acute respiratory failure
- Barotrauma
- Pneumothorax
- High flow nasal cannula
- Invasive mechanical ventilation
