Stephanie Chang
Cedars Sinai Medical Center
Los Angeles, California
Disclosure information not submitted.
Divya Narayanan, MD
Resident Physician
Cedars-Sinai Medical Center, United States
Disclosure information not submitted.
Josephine Hwang, MD
Resident Physician
Cedars-Sinai Medical Center, United States
Disclosure information not submitted.
Peter Chen, MD
Director, Division of Pulmonary and Critical Care Medicine
Cedars-Sinai Medical Center, United States
Disclosure information not submitted.
Tanyalak Parimon, MD
Assistant Professor, Department of Medicine in the Pulmonary Disease and Critical Care Division
Cedars-Sinai Medical Center, United States
Disclosure information not submitted.
Title: Barotrauma Associated With COVID-19 ARDS: A Single-Center Report
Introduction:
Barotrauma is a complication seen in COVID-19 pneumonia seen in 1% of hospitalized patients to 15% in mechanically ventilated patients. To date, one report found a higher incidence and mortality in COVID-19 patients with barotrauma during the winter surge. Still, risk factors were inconclusive. Since the clinical course and management of COVID-19 is evolving, some variables may impact the higher barotrauma incidence during winter surge warranting further study.
Methods:
A single-center IRB-approved retrospective analysis of barotrauma (defined as pneumothorax (PTX) and pneumomediastinum (PMD), or both), among COVID-19 cases admitted between March 2020 and January 2021 was performed. The spring surge was defined to be March to May 2020, and the winter surge December 2020 to January 2021. Incidence and mortality rates were calculated over the total study period and each surge.
Results:
Among 2,545 COVID-19 cases, 54 developed barotrauma, corresponding to an incidence rate (IR) of 2.12%. Of those, 40 (74.0%) were mechanically ventilated. The IR during the spring and winter surges were 1.36% and 2.23%, respectively. The all-cause mortality rate (MR) was 14.9% (381 of 2,545). The winter all-cause mortality rate was higher at 17.4% (65 of 442) than the spring at 14.7% (234 of 1,344). Among patients with barotrauma, the overall MR was 61.1% (33 of 54) and 77.5% (31 of 40) in those mechanically ventilated. The MR of patients with barotrauma was higher during the winter at 60% (18 of 30), compared to 50% (3 of 6) during the spring. Patients with barotrauma were between the ages of 60-69 years (29.6%), male (70.4%), Hispanic (70.4%), and without smoking history (66.7%). The most common comorbidities were hypertension (63.0%) and diabetes (40.7%).
Conclusions:
Our results concurred with an earlier report that the incidence and mortality associated with barotrauma among COVID-19 inpatients during the winter were higher than in the spring. The finding raises a concern for period-specific risk factors. Further analyses of clinical variables and ventilator parameters associated with the higher winter incidence and mortality are ongoing. The results will provide clinical guidance in identifying COVID-19 patients at risk for barotrauma to allow clinicians to implement appropriate preventive preventative measures.