8/29/2023 0 Comments Treatment for pulmonary barotrauma![]() In our institution, we had several patients with pulmonary barotrauma of varying severity who were treated based on clinical and radiologic findings. The other ways to differentiate are respiratory system elastance and recruitability. According to Gattinoni et al., type L and H patients are best diagnosed by a CT scan. ![]() The type H patients meet all the criteria for severe ARDS. These are the type L patients who may remain the same clinically for a certain period of time, and then, they either improve or deteriorate. The deterioration leads to high elastance, high right-to-left shunt, high lung weight, and high lung recruitability, which are referred to as type H patients. During the initial course of the disease, there is low elastance, low ventilation-to-perfusion ratio, low lung weight, and low lung recruitability. described two phenotypes for COVID-19 pneumonia: the type L and the type H. In such cases, interventions such as the placement of chest tubes or pig-tail catheters are required to relieve symptoms and improve hemodynamics and oxygenation. When barotrauma is suspected and confirmed by imaging (chest radiography or computed tomography), patients must be monitored closely for deterioration such as the sudden onset of desaturation, hypotension, sudden tachypnea, and increased oxygen demand. mentioned a mortality rate of 56% in the presence of barotrauma in patients with COVID-19 acute respiratory distress syndrome (ARDS) when compared to 36% without barotrauma. ![]() The results of the observational study by Kahn et al. Pulmonary barotrauma leads to prolonged intensive care unit (ICU) stay, increases the duration of mechanical ventilation, leads to difficult weaning from mechanical ventilation, and increases morbidity and mortality. This is referred to as “patient-self-inflicted lung injury” (P-SILI). The high respiratory drive present in patients with underlying severe lung injury leads to the intense respiratory effort that exacerbates the underlying lung injury and manifests as pulmonary barotrauma. During the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), clinicians encountered many patients who developed barotrauma of varying types and severity during invasive/non-invasive ventilation, and even during spontaneous breathing in some cases. This leads to air leakage into extra-alveolar tissue, which leads to pneumomediastinum, subcutaneous emphysema, pneumothorax, and pneumoperitoneum. Pulmonary barotrauma refers to alveolar rupture due to increased transalveolar pressure (the difference between the alveolar pressure and the pressure in the adjacent interstitial space). We have also presented the incidence of spontaneous versus ventilator-induced barotrauma, the length of stay of these patients, the outcomes in terms of survival or death, the need for tracheostomy, secondary infections, and interventions performed as indicated. In this single-center, retrospective study at a secondary care hospital in Oman, we described our experience with patients who suffered pulmonary barotrauma during their ICU admission. Of the 28 patients, eight patients survived and were discharged from the hospital. ![]() The median number of days in the ICU was 19.5 (interquartile range: 12.5-26.5). ![]() Out of 28, five patients developed spontaneous barotrauma, 14 patients had barotrauma after initiation of non-invasive ventilation, and nine patients had barotrauma as a result of invasive ventilation. Twenty-eight patients developed barotrauma of variable severity and required interventions like the placement of intercostal drains. Patient data were collected from the Al Shifa patient information portal, which is an electronic medical record system available to all hospitals in the Ministry of Health, Oman. After identifying patients with pulmonary barotrauma, the following details were recorded and entered into an Excel sheet (Microsoft Corporation, Albuquerque, New Mexico) and a database was created, which contained the following: age, sex, smoking history, comorbidities, type, location, mode of barotrauma, mode of ventilation, length of intensive care unit (ICU) stay, interventions performed, and overall outcome (survived/deceased).Ī total of 529 patients with COVID-19 pneumonia were admitted from March 2021 to September 2021 to the ICU. Being a retrospective study, informed consent was not applicable. In pulmonary barotrauma, air leaks into extra-alveolar tissue resulting in pneumomediastinum, subcutaneous emphysema, pneumothorax, and pneumoperitoneum.Īfter obtaining institutional approval, we retrospectively reviewed data from March 1, 2021, to September 31, 2021. During the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), many patients developed pulmonary barotrauma either self-inflicted or ventilator-induced. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |