Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients

Antonio R Anzueto, Fernando Frutos-Vivar, Andres Esteban, Inmaculada Alía, Laurent Brochard, Thomas Stewart, Salvador Benito, Martin J. Tobin, Jose Elizalde, Fernando Palizas, Cide M. David, Jorge Pimentel, Marco González, Luis Soto, Gabriel D'Empaire, Paolo Pelosi

Research output: Contribution to journalArticle

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Abstract

Objective: To determine the incidence, risk factors, and outcome of barotrauma in a cohort of mechanically ventilated patients where limited tidal volumes and airway pressures were used. Design and setting: Prospective cohort of 361 intensive care units from 20 countries. Patients and participants: A total of 5183 patients mechanically ventilated for more than 12 h. Measurements and results: Baseline demographic data, primary indication for mechanical ventilation, daily ventilator settings, multiple-organ failure over the course of mechanical ventilation and outcome were collected. Barotrauma was present in 154 patients (2.9%). The incidence varied according to the reason for mechanical ventilation: 2.9% of patients with chronic obstructive pulmonary disease; 6.3% of patients with asthma; 10.0% of patients with chronic interstitial lung disease (ILD); 6.5% of patients with acute respiratory distress syndrome (ARDS); and 4.2% of patients with pneumonia. Patients with and without barotrauma did not differ in any ventilator parameter. Logistic regression analysis identified as factors independently associated with barotrauma: asthma [RR 2.58 (1.05-6.50)], ILD [RR 4.23 (95%CI 1.78-10.03)]; ARDS as primary reason for mechanical ventilation [RR 2.70 (95%CI 1.55-4.70)]; and ARDS as a complication during the course of mechanical ventilation [RR 2.53 (95%CI 1.40-4.57)]. Case-control analysis showed increased mortality in patients with barotrauma (51.4 vs 39.2%; p=0.04) and prolonged ICU stay. Conclusions: In a cohort of patients in whom airway pressures and tidal volume are limited, barotrauma is more likely in patients ventilated due to underlying lung disease (acute or chronic). Barotrauma was also associated with a significant increased in the ICU length of stay and mortality.

Original languageEnglish (US)
Pages (from-to)612-619
Number of pages8
JournalIntensive Care Medicine
Volume30
Issue number4
DOIs
StatePublished - Apr 2004

Fingerprint

Barotrauma
Incidence
Artificial Respiration
Adult Respiratory Distress Syndrome
Tidal Volume
Interstitial Lung Diseases
Mechanical Ventilators
Asthma
Pressure
Multiple Organ Failure
Mortality
Chronic Obstructive Pulmonary Disease
Lung Diseases

Keywords

  • ARDS
  • Barotrauma
  • Mechanical
  • PEEP
  • Pneumothorax
  • Tidal volume
  • Ventilation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Anzueto, A. R., Frutos-Vivar, F., Esteban, A., Alía, I., Brochard, L., Stewart, T., ... Pelosi, P. (2004). Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients. Intensive Care Medicine, 30(4), 612-619. https://doi.org/10.1007/s00134-004-2187-7

Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients. / Anzueto, Antonio R; Frutos-Vivar, Fernando; Esteban, Andres; Alía, Inmaculada; Brochard, Laurent; Stewart, Thomas; Benito, Salvador; Tobin, Martin J.; Elizalde, Jose; Palizas, Fernando; David, Cide M.; Pimentel, Jorge; González, Marco; Soto, Luis; D'Empaire, Gabriel; Pelosi, Paolo.

In: Intensive Care Medicine, Vol. 30, No. 4, 04.2004, p. 612-619.

Research output: Contribution to journalArticle

Anzueto, AR, Frutos-Vivar, F, Esteban, A, Alía, I, Brochard, L, Stewart, T, Benito, S, Tobin, MJ, Elizalde, J, Palizas, F, David, CM, Pimentel, J, González, M, Soto, L, D'Empaire, G & Pelosi, P 2004, 'Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients', Intensive Care Medicine, vol. 30, no. 4, pp. 612-619. https://doi.org/10.1007/s00134-004-2187-7
Anzueto, Antonio R ; Frutos-Vivar, Fernando ; Esteban, Andres ; Alía, Inmaculada ; Brochard, Laurent ; Stewart, Thomas ; Benito, Salvador ; Tobin, Martin J. ; Elizalde, Jose ; Palizas, Fernando ; David, Cide M. ; Pimentel, Jorge ; González, Marco ; Soto, Luis ; D'Empaire, Gabriel ; Pelosi, Paolo. / Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients. In: Intensive Care Medicine. 2004 ; Vol. 30, No. 4. pp. 612-619.
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abstract = "Objective: To determine the incidence, risk factors, and outcome of barotrauma in a cohort of mechanically ventilated patients where limited tidal volumes and airway pressures were used. Design and setting: Prospective cohort of 361 intensive care units from 20 countries. Patients and participants: A total of 5183 patients mechanically ventilated for more than 12 h. Measurements and results: Baseline demographic data, primary indication for mechanical ventilation, daily ventilator settings, multiple-organ failure over the course of mechanical ventilation and outcome were collected. Barotrauma was present in 154 patients (2.9{\%}). The incidence varied according to the reason for mechanical ventilation: 2.9{\%} of patients with chronic obstructive pulmonary disease; 6.3{\%} of patients with asthma; 10.0{\%} of patients with chronic interstitial lung disease (ILD); 6.5{\%} of patients with acute respiratory distress syndrome (ARDS); and 4.2{\%} of patients with pneumonia. Patients with and without barotrauma did not differ in any ventilator parameter. Logistic regression analysis identified as factors independently associated with barotrauma: asthma [RR 2.58 (1.05-6.50)], ILD [RR 4.23 (95{\%}CI 1.78-10.03)]; ARDS as primary reason for mechanical ventilation [RR 2.70 (95{\%}CI 1.55-4.70)]; and ARDS as a complication during the course of mechanical ventilation [RR 2.53 (95{\%}CI 1.40-4.57)]. Case-control analysis showed increased mortality in patients with barotrauma (51.4 vs 39.2{\%}; p=0.04) and prolonged ICU stay. Conclusions: In a cohort of patients in whom airway pressures and tidal volume are limited, barotrauma is more likely in patients ventilated due to underlying lung disease (acute or chronic). Barotrauma was also associated with a significant increased in the ICU length of stay and mortality.",
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AU - Frutos-Vivar, Fernando

AU - Esteban, Andres

AU - Alía, Inmaculada

AU - Brochard, Laurent

AU - Stewart, Thomas

AU - Benito, Salvador

AU - Tobin, Martin J.

AU - Elizalde, Jose

AU - Palizas, Fernando

AU - David, Cide M.

AU - Pimentel, Jorge

AU - González, Marco

AU - Soto, Luis

AU - D'Empaire, Gabriel

AU - Pelosi, Paolo

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N2 - Objective: To determine the incidence, risk factors, and outcome of barotrauma in a cohort of mechanically ventilated patients where limited tidal volumes and airway pressures were used. Design and setting: Prospective cohort of 361 intensive care units from 20 countries. Patients and participants: A total of 5183 patients mechanically ventilated for more than 12 h. Measurements and results: Baseline demographic data, primary indication for mechanical ventilation, daily ventilator settings, multiple-organ failure over the course of mechanical ventilation and outcome were collected. Barotrauma was present in 154 patients (2.9%). The incidence varied according to the reason for mechanical ventilation: 2.9% of patients with chronic obstructive pulmonary disease; 6.3% of patients with asthma; 10.0% of patients with chronic interstitial lung disease (ILD); 6.5% of patients with acute respiratory distress syndrome (ARDS); and 4.2% of patients with pneumonia. Patients with and without barotrauma did not differ in any ventilator parameter. Logistic regression analysis identified as factors independently associated with barotrauma: asthma [RR 2.58 (1.05-6.50)], ILD [RR 4.23 (95%CI 1.78-10.03)]; ARDS as primary reason for mechanical ventilation [RR 2.70 (95%CI 1.55-4.70)]; and ARDS as a complication during the course of mechanical ventilation [RR 2.53 (95%CI 1.40-4.57)]. Case-control analysis showed increased mortality in patients with barotrauma (51.4 vs 39.2%; p=0.04) and prolonged ICU stay. Conclusions: In a cohort of patients in whom airway pressures and tidal volume are limited, barotrauma is more likely in patients ventilated due to underlying lung disease (acute or chronic). Barotrauma was also associated with a significant increased in the ICU length of stay and mortality.

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KW - PEEP

KW - Pneumothorax

KW - Tidal volume

KW - Ventilation

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