H-Index
17
Scimago Lab
powered by Scopus
eISSN: 1941-5923
call: +1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Logo

Medical Science Monitor Basic Research
MSMbanner

Annals
ISI-Home

Get your full text copy in PDF

Pulmonary Barotrauma Resulting from Mechanical Ventilation in 2 Patients with a Diagnosis of COVID-19 Pneumonia

Raphael Ezeagu, Titilope Olanipekun, Ratnam Santoshi, Chanaka Seneviratne, Yizhak Kupfer

(Department of Pulmonary and Critical Care, Maimonides Medical Center, Brooklyn, NY, USA)

Am J Case Rep 2021; 22:e927954

DOI: 10.12659/AJCR.927954


BACKGROUND: Invasive mechanical ventilation can cause pulmonary barotrauma due to elevated transpulmonary pressure and alveolar rupture. A significant proportion of COVID-19 patients with acute respiratory distress syndrome (ARDS) will require mechanical ventilation. We present 2 interesting cases that demonstrate the possibility of COVID-19-associated ARDS manifesting with pulmonary barotrauma at acceptable ventilatory pressures.
CASE REPORT: The first patient was a 71-year-old man who was intubated and placed on mechanical ventilation due to hypoxemic respiratory failure from SARS-CoV-2 infection. His partial pressure of O2 to fraction of inspired oxygen ratio (PaO2/FiO2) was 156. He developed subcutaneous emphysema (SE) and pneumomediastinum on day 5 of mechanical ventilation at ventilatory settings of positive end-expiratory pressure (PEEP) ≤15 cmH₂O, plateau pressure (Pplat) ≤25 cmH₂O and pulmonary inspiratory pressure (PIP) ≤30 cmH₂O. He was managed with ‘blow-hole’ incisions, with subsequent clinical resolution of subcutaneous emphysema. The second patient was a 58-year-old woman who was also mechanically ventilated due to hypoxemic respiratory failure from COVID-19, with PaO2/FiO2 of 81. She developed extensive SE with pneumomediastinum and pneumothorax while on mechanical ventilation settings PEEP 13 cmH₂O and PIP 28 cmH₂O, Pplat 18 cmH₂O, and FiO2 90%. SE was managed with blow-hole incisions and pneumothorax with chest tube.
CONCLUSIONS: Clinicians should be aware of pulmonary barotrauma as a possible complication of COVID-19 pulmonary disease, even at low ventilatory pressures.

This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
I agree