Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients |
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Authors: | Antonio Anzueto Fernando Frutos–Vivar Andres Esteban Inmaculada Alía Laurent Brochard Thomas Stewart Salvador Benito Martin J. Tobin Jose Elizalde Fernando Palizas Cide M. David Jorge Pimentel Marco González Luis Soto Gabriel D’Empaire Paolo Pelosi |
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Affiliation: | (1) Department of Medicine, Division of Pulmonary Medicine/Critical Care Medicine, University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System, Audie L. Murphy Memorial Veterans Hospital Division, San Antonio, Texas, USA;(2) Hospital Universitario de Getafe, Madrid, Spain;(3) Hospital Henri Mondor, Creteil, France;(4) Mount Sinai Hospital, University of Toronto, Toronto, Canada;(5) Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;(6) Loyola University, Chicago and Hines Veterans Affairs Hospital, Hines, Illinois, USA;(7) Hospital ABC, Mexico City, Mexico;(8) Clinica Bazterrica, Buenos Aires, Argentina;(9) Hospital Universitario Clementito Fraga Filho, Rio de Janeiro, Brazil;(10) Hospital da Universidade, Coimbra, Portugal;(11) Hospital General de Medellin, Medellin, Colombia;(12) Instituto Nacional del Torax, Santiago de Chile, Chile;(13) Hospital de Clinicas, Caracas, Venezuela;(14) UniversitadellInsubria, Hospedale di Circolo, Varese, Italy;(15) Present address: 7400 Merton Minter Boulevard, 11E, San Antonio, Texas 78229, USA |
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Abstract: | Objective To determine the incidence, risk factors, and outcome of barotrauma in a cohort of mechanically ventilated patients where limited tidal volumes and airway pressures were used.Design and setting Prospective cohort of 361 intensive care units from 20 countries.Patients and participants A total of 5183 patients mechanically ventilated for more than 12 h.Measurements and results Baseline demographic data, primary indication for mechanical ventilation, daily ventilator settings, multiple-organ failure over the course of mechanical ventilation and outcome were collected. 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); and 4.2% of patients with pneumonia. Patients with and without barotrauma did not differ in any ventilator parameter. 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)]; and 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.Conclusions 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 increased in the ICU length of stay and mortality.Electronic Supplementary Material Supplementary Material is available in the online version of this article at |
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Keywords: | Barotrauma Pneumothorax Mechanical ventilation Tidal volume PEEP ARDS |
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