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Abstract：
BACKGROUND: The risk of barotrauma associated with different types of ventilatory support is unclear in COVID-19 patients. The primary aim of this study was to evaluate the effect of the different respiratory support strategies on barotrauma occurrence; we also sought to determine the frequency of barotrauma and the clinical characteristics of the patients who experienced this complication.
METHODS: This multicentre retrospective case-control study from 1 March 2020 to 28 February 2021 included COVID-19 patients who experienced barotrauma during hospital stay. They were matched with controls in a 1:1 ratio for the same admission period in the same ward of treatment. Univariable and multivariable logistic regression (OR) were performed to explore which factors were associated with barotrauma and in-hospital death.
RESULTS: We included 200 cases and 200 controls. Invasive mechanical ventilation was used in 39.3% of patients in the barotrauma group, and in 20.1% of controls (p<0.001). Receiving non-invasive ventilation (C-PAP/PSV) instead of conventional oxygen therapy (COT) increased the risk of barotrauma (OR 5.04, 95% CI 2.30 - 11.08, p<0.001), similarly for invasive mechanical ventilation (OR 6.24, 95% CI 2.86-13.60, p<0.001). High Flow Nasal Oxygen (HFNO), compared with COT, did not significantly increase the risk of barotrauma. Barotrauma frequency occurred in 1.00% [95% CI 0.88-1.16] of patients; these were older (p=0.022) and more frequently immunosuppressed (p=0.013). Barotrauma was shown to be an independent risk for death (OR 5.32, 95% CI 2.82-10.03, p<0.001).
CONCLUSIONS: C-PAP/PSV compared with COT or HFNO increased the risk of barotrauma; otherwise HFNO did not. Barotrauma was recorded in 1.00% of patients, affecting mainly patients with more severe COVID-19 disease. Barotrauma was independently associated with mortality.
BACKGROUND: this case-control study was prospectively registered in clinicaltrial.gov as NCT04897152 (on 21 May 2021).
METHODS: This multicentre retrospective case-control study from 1 March 2020 to 28 February 2021 included COVID-19 patients who experienced barotrauma during hospital stay. They were matched with controls in a 1:1 ratio for the same admission period in the same ward of treatment. Univariable and multivariable logistic regression (OR) were performed to explore which factors were associated with barotrauma and in-hospital death.
RESULTS: We included 200 cases and 200 controls. Invasive mechanical ventilation was used in 39.3% of patients in the barotrauma group, and in 20.1% of controls (p<0.001). Receiving non-invasive ventilation (C-PAP/PSV) instead of conventional oxygen therapy (COT) increased the risk of barotrauma (OR 5.04, 95% CI 2.30 - 11.08, p<0.001), similarly for invasive mechanical ventilation (OR 6.24, 95% CI 2.86-13.60, p<0.001). High Flow Nasal Oxygen (HFNO), compared with COT, did not significantly increase the risk of barotrauma. Barotrauma frequency occurred in 1.00% [95% CI 0.88-1.16] of patients; these were older (p=0.022) and more frequently immunosuppressed (p=0.013). Barotrauma was shown to be an independent risk for death (OR 5.32, 95% CI 2.82-10.03, p<0.001).
CONCLUSIONS: C-PAP/PSV compared with COT or HFNO increased the risk of barotrauma; otherwise HFNO did not. Barotrauma was recorded in 1.00% of patients, affecting mainly patients with more severe COVID-19 disease. Barotrauma was independently associated with mortality.
BACKGROUND: this case-control study was prospectively registered in clinicaltrial.gov as NCT04897152 (on 21 May 2021).
摘要：
背景：在COVID-19患者中，与不同类型的通气支持相关的气压伤风险尚不清楚。这项研究的主要目的是评估不同呼吸支持策略对气压伤发生的影响；我们还试图确定气压伤的频率和经历这种并发症的患者的临床特征。
方法：这项2020年3月1日至2021年2月28日的多中心回顾性病例对照研究包括住院期间经历气压伤的COVID-19患者。在同一病房的同一入院期间，他们与对照组以1：1的比例匹配。进行单变量和多变量逻辑回归（OR）以探讨哪些因素与气压伤和住院死亡有关。
结果：我们包括200例病例和200例对照。气压伤组39.3%的患者采用有创机械通气,和20.1%的对照组（p<0.001）。接受无创通气（C-PAP/PSV）而不是常规氧疗（COT）会增加气压伤的风险（OR5.04，95％CI2.30-11.08，p<0.001），有创机械通气也是如此(OR6.24,95%CI2.86-13.60,p<0.001)。高流量鼻氧（HFNO），与COT相比，并没有显着增加气压伤的风险。1.00%[95%CI0.88-1.16]的患者发生气压伤；这些患者年龄较大(p=0.022)，更常见的是免疫抑制(p=0.013)。显示气压伤是死亡的独立风险（OR5.32，95％CI2.82-10.03，p<0.001）。
结论：与COT或HFNO相比，C-PAP/PSV增加了气压伤的风险；否则HFNO没有。在1.00%的患者中记录了气压伤，主要影响患有更严重COVID-19疾病的患者。气压伤与死亡率独立相关。
背景：该病例对照研究在clinicaltrial.gov中前瞻性注册为NCT04897152（2021年5月21日）。
方法：这项2020年3月1日至2021年2月28日的多中心回顾性病例对照研究包括住院期间经历气压伤的COVID-19患者。在同一病房的同一入院期间，他们与对照组以1：1的比例匹配。进行单变量和多变量逻辑回归（OR）以探讨哪些因素与气压伤和住院死亡有关。
结果：我们包括200例病例和200例对照。气压伤组39.3%的患者采用有创机械通气,和20.1%的对照组（p<0.001）。接受无创通气（C-PAP/PSV）而不是常规氧疗（COT）会增加气压伤的风险（OR5.04，95％CI2.30-11.08，p<0.001），有创机械通气也是如此(OR6.24,95%CI2.86-13.60,p<0.001)。高流量鼻氧（HFNO），与COT相比，并没有显着增加气压伤的风险。1.00%[95%CI0.88-1.16]的患者发生气压伤；这些患者年龄较大(p=0.022)，更常见的是免疫抑制(p=0.013)。显示气压伤是死亡的独立风险（OR5.32，95％CI2.82-10.03，p<0.001）。
结论：与COT或HFNO相比，C-PAP/PSV增加了气压伤的风险；否则HFNO没有。在1.00%的患者中记录了气压伤，主要影响患有更严重COVID-19疾病的患者。气压伤与死亡率独立相关。
背景：该病例对照研究在clinicaltrial.gov中前瞻性注册为NCT04897152（2021年5月21日）。
