Pulmonary Barotrauma in COVID-19 Patients With ARDS on Invasive and Non-Invasive Positive Pressure Ventilation

Kartikeya Rajdev, Alan J. Spanel, Sean McMillan, Shubham Lahan, Brian Boer, Justin Birge, Meilinh Thi

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


Background: We experienced a high incidence of pulmonary barotrauma among patients with coronavirus disease-2019 (COVID-19) associated acute respiratory distress syndrome (ARDS) at our institution. In current study, we sought to evaluate the incidence, clinical outcomes, and characteristics of barotrauma among COVID-19 patients receiving invasive and non-invasive positive pressure ventilation. Methodology: This retrospective cohort study included adult patients diagnosed with COVID-19 pneumonia and requiring oxygen support or positive airway pressure for ARDS who presented to our tertiary-care center from March through November, 2020. Results: A total of 353 patients met our inclusion criteria, of which 232 patients who required heated high-flow nasal cannula, continuous or bilevel positive airway pressure were assigned to non-invasive group. The remaining 121 patients required invasive mechanical ventilation and were assigned to invasive group. Of the total 353 patients, 32 patients (65.6% males) with a mean age of 63 ± 11 years developed barotrauma in the form of subcutaneous emphysema, pneumothorax, or pneumomediastinum. The incidence of barotrauma was 4.74% (11/232) and 17.35% (21/121) in the non-invasive group and invasive group, respectively. The median length of hospital stay was 22 (15.7 −33.0) days with an overall mortality of 62.5% (n = 20). Conclusions: Patients with COVID-19 ARDS have a high incidence of barotrauma. Pulmonary barotrauma should be considered in patients with COVID-19 pneumonia who exhibit worsening of their respiratory disease as it is likely associated with a high mortality risk. Utilizing lung-protective ventilation strategies may reduce the risk of barotrauma.

Original languageEnglish (US)
Pages (from-to)1013-1017
Number of pages5
JournalJournal of Intensive Care Medicine
Issue number9
StatePublished - Sep 2021
Externally publishedYes


  • COVID-19
  • acute respiratory distress syndrome
  • mechanical ventilation
  • pneumomediastinum
  • pneumothorax
  • pulmonary barotrauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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