BENGALURU: Critically ill Covid-19 patients who were on respiratory support had a high incidence of barotrauma, and over half of them succumbed to their illness, a new study has found.
The study titled, 'Severe Covid 19 pneumonia and barotrauma: From the frying pan into the fire', was posted as a preprint on medRxiv on February 16. It retrospectively analysed data on 410 patients between June and November 2020 at Apollo Specialty Hospital in the Jayanagar area of Bengaluru.
Thirty-eight of 410 patients (9.3%) showed a high incidence of barotrauma during the study period, which refers to injuries in the body caused by increased air or water pressure. In this case, it refers to lung damage similar to tearing of the lung tissue, which can lead to a collection of air around the lungs. This air can also push its way out to below the skin.
Twenty (52.6%) of the 38 patients with barotrauma were on non-invasive ventilation and 18 (47.8%) were on intermittent mandatory ventilation on standard recommended settings.
Overall, 24 (63.2%) of the 38 patients, including 15 of (83.3%) 18 on mechanical ventilation, succumbed to illness due to barotrauma.
"Barotrauma is an uncommon, but known complication in patients on mechanical ventilation for various reasons. Reported incidence before the pandemic is around 2.9%," said Dr Hari Prasad, pulmonology consultant at Apollo Specialty Hospitals, and the lead author of the study.
"The cause of barotrauma is severe damage to the lungs from the disease itself, longer duration of respiratory support required by Covid-19 patients, uniform use of corticosteroids as per worldwide recommendations and infection. The barotrauma suddenly hits patients and we wouldn't know unless an ultrasound or x-ray of the lungs catches the condition fast. (If it is not caught), chances of mortality are high," said Dr Ravindra Mehta, head of pulmonology at Apollo Hospitals and one of the authors of the study.
Barotrauma occurred around a median of 6.5 days after admission and 15 days from the onset of symptoms.
The median duration from barotrauma to death was seven days, and barotrauma to discharge for survivors was 12.5 days, the study found.
The authors of the study claimed that it the first-of-its-kind in India and that it could help doctors develop or modify treatment protocol and ventilatory management of such patients. "It involves a large patient population and comprehensive analysis and enhances awareness of this complication and a wake-up call for the medical community to institute prevention and maintain vigilance for this complication in these critically ill patients," the study said.