#BAROTRAUMA MEANING SERIES#

In all cases diagnosis of COVID-19 infection was confirmed with reverse transcriptase polymerase chain reaction assays performed by nasopharyngeal swab. Information about general population demographic and mechanical ventilation setting and outcomes were collected. A single thoracic surgery service active in two of New York City Boroughs Brookdale University Hospital in Brooklyn and Jamaica Hospital in Queens, was involved in the management of these cases.

#BAROTRAUMA MEANING SERIES#

This retrospective case series include adults 18 years and older with confirmed COVID-19 infection who were admitted between March 17 th and April 17 th and developed evidence of barotrauma (subcutaneous emphysema, pneumothorax or pneumomediastinum) on plain chest radiography or computed tomography (CT) scan. It encompasses a previously unreported experience with a surprising number of barotrauma complications in COVID-19 patients with experienced severe cases of respiratory failure. It is unique in that it reviews the early experience of a Thoracic Surgery service functioning in the epicenter of the COVID-19 pandemic, the New York City boroughs of Queens and Brooklyn. This paper presents a case series review of barotrauma injuries encountered in the management of COVID-19 cases. Case reports from China also described spontaneous pneumomediastinum in COVID19 patients 17. These patients usually require high PEEP to maintain oxygenation, which increases their risk for barotrauma. This incidence is not yet documented, but previous studies have shown that patients with ARDS resulting from pneumonia may develop early barotrauma 16. Patients with COVID-19 might have a higher incidence of barotrauma. The ARDS net research found that lung-protective ventilation reduces mortality and possibly barotrauma in Acute Lung Injury (ALI) and ARDs 7,8. The incidence of barotrauma varies with the underlying indication for mechanical ventilation, and several previous studies found patients with underlying lung disease (Pneumonia, Chronic interstitial lung disease, ARDs) more prone to barotrauma compared to patients who were intubated for Septic shock or developed ARDs for a non-pulmonary insult 15. It is associated with increased morbidity and mortality 13,14. Pulmonary barotrauma in mechanical ventilation refers to alveolar rupture due to elevated trans alveolar pressure (the alveolar pressure minus the pressure in the adjacent interstitial space), which leads to air leaks into extra-alveolar tissue that can manifest as pneumothorax, pneumomediastinum, pneumoperitoneum, and subcutaneous emphysema 12. Increasing the PEEP to sustain adequate oxygenation can be at the expense of increasing Pplat and barotrauma. Studies have shown that higher PEEP strategies may improve survival in ARDS, at the possible increase risk of pneumothorax 11. Extrinsic PEEP has been utilized in ARDs to improve oxygenation, reduce Oxygen requirement (FiO2) and prevent Atelectotrauma (repeated opening and closing of alveoli), which reduce Ventilator-induced lung injury (VILI) 7.

Results: 25 patients developed evidence of barotrauma on Chest Xray or Computed tomography (CT) with a mean age of 60.1 at the time of diagnosis, 12 (48%) developed severe ARDS with PaO2/FiO2 ratio of 32 were associated with higher short-term mortality 10. Methods: The electronic medical records of all patients admitted with confirmed COVID 19 infection who eventually developed barotrauma between March 17 th, 2020 and April 17 th, 2020 were reviewed, information about patient characteristics, pattern and characteristic of barotrauma were analyzed and reported in a descriptive manner.

Mohammad Abdallat 1*, Mazhar Khalil 1, Ghayth Al-Awwa 1, Ravi Kothuru 2, Charles La Punzina 2ДЎDepartment of Surgery, Brookdale University Hospital and Medical Center, USAДўCardiothoracic Surgery, Brookdale University Hospital and Medical Center, USAД«ackground: This case series assessed the clinical outcomes and characteristics of barotrauma in COVID19 patients.

Barotrauma meaning