ARRS 2022 Abstracts

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1338. Increased Incidence of Barotrauma in COVID-19 (+) Hospitalized Patient
Authors * Denotes Presenting Author
  1. Khalid Shaqdan *; Virginia Commonwealth University Hospital
  2. Yasir Al-dojaily; Virginia Commonwealth University Hospital
  3. Shaimaa Fadl; Virginia Commonwealth University Hospital
  4. Elizabeth Proffitt; Virginia Commonwealth University Hospital
  5. Frank Dana; Virginia Commonwealth University Hospital
  6. Leila Rezai Gharai; Virginia Commonwealth University Hospital
  7. Mark Parker; Virginia Commonwealth University Hospital
Objective:
We investigate whether there is an increase in incidence of barotrauma in COVID-19 (+) patients requiring either high flow nasal cannula (HFNC) or invasive mechanical ventilation (IMV).

Materials and Methods:
Following expedited Institutional Review Board (IRB) approval, we retrospectively reviewed 506 patients with a positive reverse transcription-polymerase chain reaction (RT-PCR) test for COVID-19 (+) who were admitted between February and August 2020. Review of electronic medical records provided necessary demographic data including gender and race, clinical course, ventilator parameters, and chest x-ray findings. Barotrauma was defined as spontaneous pneumomediastinum, pneumoperitoneum, pneumopericardium, subcutaneous air, pneumatocele, and/or pneumothorax on chest x-ray. Statistical analysis was performed using SPSS software.

Results:
80 of 506 patients (16%) required IMV during their hospital course. IMV COVID (+) patients had a mean age of 60 ± 16 yrs (p < 0.0001), 58% men (p < 0.05), 64% African American, 36% other ethnicities. 13 IMV COVID (+) patients had 15 barotrauma-related events (mean age 55 ± 14 yrs, 62% women, 69% African American) including: 9 pneumothoraces, 1 pneumoperitoneum, 2 pneumomediastinum, 1 perihilar air, 1 pneumatocele, and 1 other injury. One patient had 3 separate barotrauma events. Average ventilator support time for IMV patients with barotrauma was 21 days (range 4-65d; 16d SD) (p < 0.001), with a mean hospitalization of 34 days (range 3-89d; 26d SD) (p < 0.001). Average ventilator parameters for IMV COVID (+) patients with barotrauma included: positive expiratory-end pressure (PEEP) 10.4 cm H2O, respiratory rate 28 (p < 0.05), and tidal volume 465 mL. 43 of 506 patients (9%) received only HFNC; mean age 56 ± 17 yrs (range 0.4-82 years); 63% were men (p < 0.05), 49% African American. HFNC COVID (+) patients had a mean hospitalization of 13-days (range 2-56d, 9d SD) (p < 0.00001). 1 HFNC patient developed pneumomediastinum; this patient had a 34-day-long hospital course with 25 consecutive days on HFNC, versus an average HFNC duration of 4-days (range 1-12d, 3d SD) for all others not experiencing barotrauma. 9% (46/506) of hospitalized COVID patients died while hospitalized. IMV increased the mortality to 38% (30/80) (p < 0.00001) whereas HFNC alone increased mortality to 12% (5/43) (p < 0.05). IMV barotrauma had a mortality rate of 31% (4/13) compared to a 39% (26/67) mortality for IMV patients without barotrauma. IMV barotrauma mortality was highest for African Americans at 75% (3/4) versus 0 % (0/4) for Caucasians. African Americans experienced 12 barotrauma events versus 1 for Caucasians. 16% of IMV and 2% of HFNC patients had barotrauma events compared with an expected rate of 6.5-11% reported by ARDS.net.

Conclusion:
Patients with COVID-19 requiring IMV are more often older, male, and Hispanic. COVID-19 patients requiring HFNC tend to be older, female, and African American. IMV and HFNC are both associated with a longer hospital course for males, all ethnic groups, longer ventilator duration, and higher respiratory rate parameters.