Radiological Features and Outcomes of COVID-19 Associated ARDS Patients with Barotrauma

Objective: Barotrauma developing spontaneously or associated with positive pressure ventilation applied as respiratory support therapy is reported more frequently in patients with novel coronavirus 2019 (COVID-19). In this study, we aimed to determine the incidence of barotrauma in critically-ill patients with COVID-19 associated acute respiratory distress syndrome (ARDS) who received invasive mechanical ventilation (IMV), (non-invasive mechanical ventilation NIMV) or high flow nasal oxygen therapy (HFNO) and reveal clinical features, radiological findings and outcomes of these patients. 
Materials and Methods: In this two-center study, the frequency and clinical characteristics of patients who developed barotrauma while being followed up in the ICU due to COVID-19 were retrospectively investigated. 
Results: Barotrauma was detected in 29 (4.4%) of 660 patients. Nineteen (65.5%) patients developed pneumothorax, 5 (17.2%) patients developed pneumomediastinum, 5 (17.2%) patients developed subcutaneous emphysema; 18 (62.1%) patients underwent tube thoracostomy, 11 (37.9%) patients were followed conservatively. When barotrauma developed, 17 (58.6%) patients were receiving IMV, 11 (37.9%) patients were receiving NIMV, and 1 (3.4%) patient was receiving HFNO. The mean length of stay in the ICU was 15.3±10.8 days, 19 (65.5%) of the patients died. 
Conclusion: Barotrauma is not uncommon in COVID-19 ARDS patients; It is a complication that can increase mortality and length of stay in ICU.