Barotrauma...Risks..and outcome...

In a Prospective cohort of 361 intensive care units from 20 countries.

A total of 5183 patients mechanically ventilated for more than 12 h.

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)

 4.2% of patients with pneumonia

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)]

 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.

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 increase in the ICU length of stay and mortality.