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Minerva Anestesiologica 2020 Dec 16

DOI: 10.23736/S0375-9393.20.15002-8


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 Maria VILARDO 4, Thomas LANGER 5, 6, Martina VILLA 6, Fernando FRUTOS-VIVAR 7, Alessandro SANTINI 1, Pier Francesco CARUSO 1, Sofia SPANO 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 Humanitas Clinical and Research Center IRCCS, 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 Università di 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, Ospedale di Desio, Monza, Italy; 10 ASST Monza, Ospedale San Gerardo, Monza, Italy; 11 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; 12 Università degli Studi di Milano, 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 27th to May 2nd, 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: Respiratory distress syndrome, adult; Respiration, artificial; Barotrauma; Coronavirus

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