Pulmonary barotrauma in COVID-19: A systematic review and meta-analysis

Dhan Bahadur Shrestha; Yub Raj Sedhai; Pravash Budhathoki; Ayush Adhikari; Nisheem Pokharel; Richa Dhakal; Satyasuna Kafle; Wasey Ali Yadullahi Mir; Roshan Acharya; Markos G Kashiouris; Mark S Parker

doi:10.1016/j.amsu.2021.103221

Pulmonary barotrauma in COVID-19: A systematic review and meta-analysis

Ann Med Surg (Lond). 2022 Jan:73:103221. doi: 10.1016/j.amsu.2021.103221. Epub 2022 Jan 3.

Authors

Affiliations

¹ Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, USA.
² Department of Internal Medicine, Division of Hospital Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA.
³ Department of Internal Medicine, BronxCare Health System, Bronx, NY, USA.
⁴ Department of Anesthesia and Critical Care, TU Teaching Hospital, Kathmandu, Nepal.
⁵ Department of Internal Medicine, KIST Medical College, Lalitpur, Nepal.
⁶ Department of Internal Medicine, Kathmandu Medical College, Kathmandu, Nepal.
⁷ Department of Intensive Care Unit, Bhaktapur Hospital, Bhaktapur, Nepal.
⁸ Department of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, NC, USA.
⁹ Department of Internal Medicine, Pulmonary and Critical Care, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA.
¹⁰ Department of Radiology, Division of Thoracic Imaging, Virginia Commonwealth University, School of Medicine, Richmond, VA, USA.

Abstract

Background: An ever-increasing number of studies have reported an increased incidence of spontaneous pulmonary barotrauma such as pneumothorax, pneumomediastinum, and subcutaneous emphysema in patients with COVID-19. We conducted this systematic review and meta-analysis to assess the value and significance of the available data.

Methods: A thorough systematic search was conducted to identify studies of barotrauma in hospitalized patients with COVID-19. Data analysis of case reports was done using a statistical package for the social sciences (SPSS) version 22, and meta-analysis was performed using CMA-3.

Results: We identified a total of 4488 studies after thorough database searching.118 case reports and series, and 15 observational studies were included in the qualitative analysis. Fifteen studies were included in the quantitative analysis. The observational studies reported barotrauma in 4.2% (2.4-7.3%) among hospitalized patients; 15.6% (11-21.8%) among critically ill patients; and 18.4% (13-25.3%) in patients receiving invasive mechanical ventilation, showing a linear relationship of barotrauma with the severity of the disease. In addition, barotrauma was associated with a longer length of hospital stay, more extended ICU stay, and higher in-hospital mortality. Also, a slightly higher odds of barotrauma was seen in COVID-19 ARDS compared with non-COVID-19 ARDS.

Conclusion: COVID-19 pneumonia is associated with a higher incidence of barotrauma. It presents unique challenges for invasive and non-invasive ventilation management. Further studies are required to unravel the underlying pathophysiology and develop safer management strategies.

Keywords: ARDS, Acute Respiratory Distress Syndrome; Barotrauma; COVID-19; COVID-19, Coronavirus Disease 2019; ICU, Intensive Care Unit; IMV, Invasive Mechanical Ventilation; NIPPV, Non-invasive Positive Pressure Ventilation; Pneumomediastinum; Pneumopericardium; Pneumothorax; SARS-Cov-2; Severe acute respiratory syndrome coronavirus-2; Subcutaneous emphysema.

Publication types

Review