Background: Pneumomediastinum and pneumothorax are complications which may be associated with barotrauma in mechanically ventilated patients. The current literature demonstrates unclear outcomes regarding barotrauma in critically ill patients with severe COVID-19. The purpose of this study was to examine the incidence of barotrauma in patients with severe COVID-19 pneumonia and its influence on survival. Study Design and Methods: A retrospective cohort study was performed from March 18, 2020 to May 5, 2020, with follow-up through June 18, 2020, encompassing critically ill intubated patients admitted for COVID-19 pneumonia at an academic tertiary care hospital in Brooklyn, New York. Critically ill patients with pneumomediastinum, pneumothorax, or both (n = 75) were compared to those without evidence of barotrauma (n = 206). Clinical characteristics and short-term patient outcomes were analyzed. Results: Barotrauma occurred in 75/281 (26.7%) of included patients. On multivariable analysis, factors associated with increased 30-day mortality were elevated age (HR 1.015 [95% CI 1.004-1.027], P = 0.006), barotrauma (1.417 [1.040-1.931], P = 0.027), and renal dysfunction (1.602 [1.055-2.432], P = 0.027). Protective factors were administration of remdesivir (0.479 [0.321-0.714], P < 0.001) and receipt of steroids (0.488 [0.370-0.643], P < 0.001). Conclusion: Barotrauma occurred at high rates in intubated critically ill patients with COVID-19 pneumonia and was found to be an independent risk factor for 30-day mortality.
【저자키워드】 COVID-19, coronavirus, Pneumothorax, Pneumomediastinum, barotrauma, 【초록키워드】 Severe COVID-19 pneumonia, severe COVID-19, Pneumonia, hospital, Remdesivir, outcome, mechanically ventilated patients, survival, Critically ill, Characteristics, clinical, Patient, Complication, age, Follow-up, incidence, New York, Care, patients, 30-Day mortality, Evidence, administration, steroid, Critically ill patient, retrospective cohort study, Factor, Intubated, multivariable analysis, renal dysfunction, independent risk factor, Brooklyn, analyzed, occurred, elevated, was performed, intubated patient, with COVID-19, 【제목키워드】 Ill,