A study by a team of doctors from a dedicated tertiary care COVID-19 center in Bengaluru involving 410 critically ill COVID-19 patients on life support reported a high incidence (9.3%) of barotrauma events in patients. This applies to both mechanical ventilation and other forms of respiratory assistance.
Barotrauma is tissue damage caused by a pressure-related change in the gas volume of the body compartment, similar to tearing of lung tissue, which leads to a build-up of air around the lungs. This air can also push its way and spread outwards to below skin surfaces.
The study titled “Severe COVID-19 Pneumonia and Barotrauma: From Pan to Fire” was written by a team of physicians including Ravindra M Mehta, Senior Consultant and HOD (Pulmonology and Interventional Pulmonology) and Hariprasad Kalpakam, Consultant, Pulmonology in Apollo, Jayanagar specialty hospitals. The study was published on medRxiv, the pre-print server for health sciences.
“Although rare, barotrauma is a known complication in patients on mechanical ventilation for a variety of reasons. An incidence of around 2.9% was reported before the COVID pandemic, ”Dr Mehta told The Hindu on Tuesday.
“This is a retrospective study of barotrauma associated with COVID acute respiratory distress syndrome (ARDS) over five months in patients on positive pressure respiratory support (PPRS) in our hospital. The type of barotrauma, the procedure, related factors, such as the type of respiratory assistance (invasive mechanical ventilation versus non-invasive ventilation), airway pressure before the onset of barotrauma, and post-barotraumatic results have been analyzed, ”he explained.
“Barotrauma has been described in MERS and SARS-CoV-1 and very few reports in SARS-CoV-2. This complication can occur at any time in critically ill COVID-19 patients. If not taken on time it can be life threatening, ”he said.
Stating that barotrauma is one of the reasons for the high mortality, the doctor explained, “The cause is severely damaged lungs, the longer duration of respiratory support required by COVID-19 patients and the consistent use of corticosteroids and infection. The clinical outcome is worse for these patients, as it manifests itself suddenly followed by a descent.
Of the 410 COVID-ARDS patients on PPRS, 38 (9.3%) developed barotrauma. Of these, 20 (52.6%) were on non-invasive ventilation and 18 (47.4%) were on invasive mechanical ventilation.
“Overall, 24 of 38 patients (63.2%) succumbed to their disease. Barotrauma occurred on average 6.5 days after admission and 15 days after symptom onset. The median time from barotrauma to death was seven days and barotrauma to discharge (for survivors) was 12.5 days. All patients received steroids and 11 of 38 (28.9%) received additional immunosuppression with tocilizumab, an interleukin 6 (IL-6) receptor inhibitor, ”according to the study.
The study highlights the importance of a high level of awareness of this complication, which may help to modify treatment protocols and ventilator management.