High Incidence of Barotrauma in Patients with COVID-19 Infection on Invasive Mechanical Ventilation
High Incidence of Barotrauma in Patients with COVID-19 Infection on Invasive Mechanical Ventilation
复制标题
有创机械通气的 COVID-19 感染患者气压伤发生率较高
作者：
G. McGuinness;C. Zhan;N. Rosenberg;L. Azour;Maj Wickstrom;Derek Mason;K. Thomas;W. Moore
背景我们观察到在我们的机构中有大量COVID-19肺炎患者患有与有创机械通气相关的气压伤。目的确定COVID-19感染患者的气压伤发生率是否高于本机构需要有创机械通气的其他患者。方法在这项回顾性研究中，将2020年1月3日至2020年6月4日期间COVID-19检测阳性并经历有创机械通气相关气压伤的患者的临床和影像学数据与同期未感染COVID-19的患者进行比较。对我院2016年2月1日至2020年2月1日急性呼吸窘迫综合征（ARDS）患者的气压伤发生率进行历史比较。适当时使用分类或连续统计检验和多变量回归分析对患者组进行比较。使用Kaplan-Meier曲线分析评估患者存活率。结果601例COVID-19感染患者接受了有创机械通气（63 ± 15岁，71%男性）。有89/601例（15%）患者发生了1起或多起气压伤事件，共计145起气压伤事件（24%的总体事件）（95% CI 21-28%）。在同一时期，196例无COVID-19感染的有创机械通气患者（64 ± 19岁，52%为男性）发生了1起气压伤事件（0.5%95%CI，0- 3%，p<0.001，与COVID-19感染组相比）。在过去4年接受有创机械通气的285例ARDS患者（68 ± 17岁，60%男性）中，28例患者（10%）发生了31起气压伤事件，总体气压伤发生率为11%（95% CI 8- 15%，p<0.001，与COVID-19感染组相比）。气压伤是COVID-19死亡的独立风险因素（OR=2.2，p= 0.03），并与住院时间较长相关（OR= 0.92，p<0.001）。结论COVID-19感染和有创机械通气患者的气压伤发生率高于ARDS患者和非COVID-19感染患者。
Background We observed a high number of patients with COVID-19 pneumonia who had barotrauma related to invasive mechanical ventilation at our institution. Purpose To determine if the rate of barotrauma in patients with COVID-19 infection was greater than other patients requiring invasive mechanical ventilation at our institution. Methods In this retrospective study, clinical and imaging data of patients seen between 03/01/2020 and 04/06/2020 who tested positive for COVID-19 and experienced barotrauma associated with invasive mechanical ventilation were compared to patients without COVID-19 infection during the same period. Historical comparison was made to barotrauma rates of patients with acute respiratory distress syndrome (ARDS) from 02/01/2016 to 02/01/2020 at our institution. Comparison of patient groups was performed using categorical or continuous statistical testing as appropriate with multivariable regression analysis. Patient survival was assessed using Kaplan-Meier curves analysis. Results 601 patients with COVID-19 infection underwent invasive mechanical ventilation (63 ± 15 years, 71% men). There were 89/601 (15%) patients with one or more barotrauma events, for a total of 145 barotrauma events (24% overall events) (95% CI 21-28%). During the same period, 196 patients without COVID-19 infection (64 ± 19 years, 52% male) with invasive mechanical ventilation had 1 barotrauma event (.5% 95% CI, 0-3%, p<.001 vs. the group with COVID-19 infection). Of 285 patients with ARDS over the prior 4 years on invasive mechanical ventilation (68 ± 17 years, 60% men), 28 patients (10%) had 31 barotrauma events, with overall barotrauma rate of 11% (95% CI 8-15%, p<.001 vs. the group with COVID-19 infection). Barotrauma is an independent risk factor for death in COVID-19 (OR=2.2, p=.03), and is associated with longer hospital length of stay (OR=.92, p<.001). Conclusion Patients with COVID-19 infection and invasive mechanical ventilation had a higher rate of barotrauma than patients with ARDS and patients without COVID-19 infection.
影响因子：
158.5
作者：
Brower, RG;Matthay, MA;Sibbald, WJ
通讯作者：
Sibbald, WJ