SARS-CoV-2 severe acute respiratory syndrome (SARS) coronavirus 2 Patients with COVID-19 pneumonia are susceptible to pulmonary barotrauma.Many patients with COVID-19 pneumonia require mechanical ventilation.Pulmonary barotrauma is a risk of mechanical ventilation.Further studies are needed to evaluate the indication and outcome of thoracostomies and conservative management. Despite high ventilatory pressures, tension pneumothorax is rare and barotrauma could potentially be managed conservatively. Conclusions:īarotrauma is a common complication of mechanical ventilation of COVID-19 patients. Interventions were 4/13 chest tubes and 2/13 pigtail catheters. The average days on ventilator was 3.4, average positive expiratory-end pressure 15.5 cmH2O, dynamic compliance 33.8 mL/cmH2O, and P/F ratio 165. Barotrauma presentations included 3/13 pneumothoraces and pneumomediastinum, 12/13 pneumomediastinum and subcutaneous emphysema, and 1/13 pneumothorax alone. Most common presenting symptoms were cough (84.6%) and dyspnea (76.9%). Majority of patients were Black race (92.3%), older than age 65 (56.8%), male (69.2%), and had comorbidities (76.9%). Of the 574 COVID-19 positive patients, 139 (24.2%) needed mechanical ventilation and 13 (9.4%) of those developed barotrauma. Descriptive analyses and Mann-Whitney U test were performed, where appropriate. Barotrauma was defined as pneumomediastinum, subcutaneous emphysema, and or pneumothorax on chest X-ray. Patient demographics, clinical course, ventilatory parameters, and radiographic results were obtained from electronic medical records. Retrospective case series study of 13 adult, mechanically ventilated, laboratory-confirmed COVID-19 positive patients admitted between and to a community hospital in New York City. To describe the presentation, characteristics, and management of mechanically ventilated patients with COVID-19 who developed barotrauma. Barotrauma is a well-documented complication of mechanical ventilation. Complications include local infiltration of gas into the damaged tissue or local circulation interfering with organ function or resulting in circulatory compromise.Ĭopyright © 2023, StatPearls Publishing LLC.Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may result in hypoxic respiratory failure necessitating mechanical ventilation. Damage occurs due to over tension or shear forces from the expansion of the gas within or by pressure hydrostatically transmitted through the tissues. Barotrauma is an injury inflicted by a difference in pressure between a gas inside or outside the body and the pressure of the surrounding gas or fluid. Pulmonary barotrauma most often occurs during ascent and is due to lung overexpansion when a SCUBA diver returns to the surface without exhaling or when the air becomes trapped in the lung. It can happen during descent (negative pulmonary barotrauma or lung squeeze) or during ascent (positive pulmonary barotrauma is also known as pulmonary overinflation syndrome (POIS). Pulmonary barotrauma can occur during self-contained underwater breathing apparatus (SCUBA) diving or free diving. Pulmonary barotrauma is a potential diving injury. The workers would often have intense back pain that left them bent over, which is how caisson disease earned the nickname "the bends." This was due to their being rested at the start of the shift compared to being exhausted when the workday was through. The caisson workers often said that they felt well while working. These symptoms included dizzy spells, difficulty breathing, and sharp pain in the abdomen or joints. Symptoms of caisson disease were observed among bridge workers after finishing their shifts underwater and coming back to the surface. Diving as a profession can be dated back to more than 5000 years, yet diving-related diseases were not described until Paul Bert wrote about caisson disease in 1878. Many people dive for recreation, competitive sport, commercial employment, and military training. It is enjoyed by novices and professionals alike.
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