Incidence of Barotrauma in COVID19 Patients Requiring Mechanical Ventilation: A Retrospective Study in a Community Hospital

Abstract

Rationale: SARS-CoV-2 causing COVID19 has led to a pandemic with over 70 million cases worldwide as well as more than 18 million cases here in the US. Acute Respiratory Distress Syndrome (ARDS) is a severe complication of this disease and traditional ventilation strategies using ARDSNet protocol, including low tidal volumes, appear to cause barotrauma in COVID19 patients at a higher rate than non-COVID19 ARDS patients. The purpose of our retrospective chart review is to identify the incidence of barotrauma in COVID19 patients with ARDS requiring mechanical ventilation here at SJMC. Methods: This study was a retrospective chart review of all patients admitted to critical care units at SJMC with COVID19 infection and requiring mechanical ventilation from March 1, 2020-September 30, 2020. The sample included adult patients (over age 18) with ICD 10 Code for COVID19 (U07.1) and patients who were placed on mechanical ventilation for greater than 24 hours, from March 1, 2020 to September 30, 2020. Both ICD 10 codes and a chart search were utilized to determine which ventilated COVID19 patients developed barotrauma. Results: 140 COVID19 patients underwent mechanical ventilation for greater than 24 hours from March 1, 2020 to September 30, 2020 at our facility. 26 COVID19 patients (18.6%) met our inclusion criteria, developing barotrauma during their hospital admission, of which 25 (17.9%) underwent mechanical (invasive and/or non-invasive) ventilation. The 1 non-ventilated patient was found to have incidental pneumothorax on chest x-ray after a thoracentesis was performed. 80% of the patients were on non-invasive mechanical ventilation prior to intubation and invasive mechanical ventilation. The categorical breakdown of barotrauma was as follows: Pneumothorax 65.4%, subcutaneous emphysema 61.5%, pneumomediastinum 34.6% and pneumoperitoneum 7.7%. None of these patients had any previous history of documented barotrauma. At the time of barotrauma, 15.4% of patients were on NMB drips, 96.2% were on corticosteroids, 42.3% were undergoing proning and 92.3% were on sedation. Prior to the time of barotrauma, 17 patients were on volume control, 7 were on pressure control and 1 was not on mechanical ventilation. Of the 17 patients on volume control, only 1 patient was above the ARDSNet guideline of 6-8 mL/kg IBW. The 7 patients on pressure control had a PEEP ranging from 8 to 15 and a PIP ranging from 25 to 46. Conclusions: Patients with COVID19 who underwent mechanical ventilation developed barotrauma at a higher rate than reported in literature for non-COVID19 patients with ARDS.