ORIGINAL ARTICLE   

Minerva Anestesiologica 2021 February;87(2):193-8

DOI: 10.23736/S0375-9393.20.15002-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Barotrauma in mechanically ventilated patients with Coronavirus disease 2019: a survey of 38 hospitals in Lombardy, Italy

Alessandro PROTTI ^{1, 2}, Massimiliano GRECO ^{1, 2} ✉, Matteo FILIPPINI ³, Anna M. VILARDO ⁴, Thomas LANGER ^{5, 6}, Martina VILLA ⁶, Fernando FRUTOS-VIVAR ⁷, Alessandro SANTINI ¹, Pier F. CARUSO ^{1, 2}, Sofia SPANO ^{1, 2}, Antonio ANZUETO ⁸, Giuseppe CITERIO ^{6, 9}, Giacomo BELLANI ^{6, 10}, Giuseppe FOTI ^{6, 10}, Roberto FUMAGALLI ^{5, 6}, Antonio PESENTI ^{11, 12}, Giacomo GRASSELLI ^{11, 12}, Maurizio CECCONI ^{1, 2}

¹ Department of Anesthesiology and Intensive Care Units, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; ² Humanitas University, Pieve Emanuele, Milan, Italy; ³ ASST Spedali Civili, Brescia, Italy; ⁴ ASST Pavia, Ospedale Civile di Voghera, Voghera, Pavia, Italy; ⁵ ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; ⁶ University of Milano-Bicocca, Milan, Italy; ⁷ Hospital Universitario de Getafe, Madrid, Spain; ⁸ University of Texas Health, and South Texas Veterans Health Care System, San Antonio, TX, USA; ⁹ ASST Monza, Hospital of Desio, Monza, Monza-Brianza, Italy; ¹⁰ ASST Monza, San Gerardo Hospital, Monza, Monza-Brianza, Italy; ¹¹ Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; ¹² University of Milan, Milan, Italy

BACKGROUND: The aim was to describe the incidence and risk factors of barotrauma in patients with the Coronavirus disease 2019 (COVID-19) on invasive mechanical ventilation, during the outbreak in our region (Lombardy, Italy).
METHODS: The study was an electronic survey open from March 27^th to May 2^nd, 2020. Patients with COVID-19 who developed barotrauma while on invasive mechanical ventilation from 61 hospitals of the COVID-19 Lombardy Intensive Care Unit network were involved.
RESULTS: The response rate was 38/61 (62%). The incidence of barotrauma was 145/2041 (7.1%; 95%-CI: 6.1-8.3%). Only a few cases occurred with ventilatory settings that may be considered non-protective such as a plateau airway pressure >35 cmH2O (2/113 [2%]), a driving airway pressure >15 cmH2O (30/113 [27%]), or a tidal volume >8 mL/kg of ideal body weight and a plateau airway pressure >30 cmH2O (12/134 [9%]).
CONCLUSIONS: Within the limits of a survey, patients with COVID-19 might be at high risk for barotrauma during invasive (and allegedly lung-protective) mechanical ventilation.

KEY WORDS: Barotrauma; COVID-19; Respiration, artificial