{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T16:58:26Z","timestamp":1781456306051,"version":"3.54.1"},"reference-count":41,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T00:00:00Z","timestamp":1684972800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Noninvasive respiratory support (NIRS) has been extensively used during the COVID-19 surge for patients with acute respiratory failure. However, little data are available about barotrauma during NIRS in patients treated outside the intensive care unit (ICU) setting. Methods: COVIMIX-2 was an ancillary analysis of the previous COVIMIX study, a large multicenter observational work investigating the frequencies of barotrauma (i.e., pneumothorax and pneumomediastinum) in adult patients with COVID-19 interstitial pneumonia. Only patients treated with NIRS outside the ICU were considered. Baseline characteristics, clinical and radiological disease severity, type of ventilatory support used, blood tests and mortality were recorded. Results: In all, 179 patients were included, 60 of them with barotrauma. They were older and had lower BMI than controls (p &lt; 0.001 and p = 0.045, respectively). Cases had higher respiratory rates and lower PaO2\/FiO2 (p = 0.009 and p &lt; 0.001). The frequency of barotrauma was 0.3% [0.1\u20131.3%], with older age being a risk factor for barotrauma (OR 1.06, p = 0.015). Alveolar-arterial gradient (A-a) DO2 was protective against barotrauma (OR 0.92 [0.87\u20130.99], p = 0.026). Barotrauma required active treatment, with drainage, in only a minority of cases. The type of NIRS was not explicitly related to the development of barotrauma. Still, an escalation of respiratory support from conventional oxygen therapy, high flow nasal cannula to noninvasive respiratory mask was predictive for in-hospital death (OR 15.51, p = 0.001). Conclusions: COVIMIX-2 showed a low frequency for barotrauma, around 0.3%. The type of NIRS used seems not to increase this risk. Patients with barotrauma were older, with more severe systemic disease, and showed increased mortality.<\/jats:p>","DOI":"10.3390\/jcm12113675","type":"journal-article","created":{"date-parts":[[2023,5,26]],"date-time":"2023-05-26T02:00:19Z","timestamp":1685066419000},"page":"3675","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Barotrauma during Noninvasive Respiratory Support in COVID-19 Pneumonia Outside ICU: The Ancillary COVIMIX-2 Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3745-8368","authenticated-orcid":false,"given":"Luigi","family":"Vetrugno","sequence":"first","affiliation":[{"name":"Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy"},{"name":"Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1626-3177","authenticated-orcid":false,"given":"Cristian","family":"Deana","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Venezia Giulia, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4660-0450","authenticated-orcid":false,"given":"Nadia","family":"Castaldo","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Department of Cardio-Thoracic Surgery, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5707-775X","authenticated-orcid":false,"given":"Alberto","family":"Fantin","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Department of Cardio-Thoracic Surgery, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3131-0565","authenticated-orcid":false,"given":"Alessandro","family":"Belletti","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6247-5958","authenticated-orcid":false,"given":"Emanuela","family":"Sozio","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0445-9578","authenticated-orcid":false,"given":"Maria","family":"De Martino","sequence":"additional","affiliation":[{"name":"Department of Medical Area, University of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6391-1720","authenticated-orcid":false,"given":"Miriam","family":"Isola","sequence":"additional","affiliation":[{"name":"Department of Medical Area, University of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7906-540X","authenticated-orcid":false,"given":"Diego","family":"Palumbo","sequence":"additional","affiliation":[{"name":"Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6970-7202","authenticated-orcid":false,"given":"Federico","family":"Longhini","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater, Domini, Magna Graecia University, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianmaria","family":"Cammarota","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care, Department of Translational medicine, Faculty of Medicine and Surgery, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5027-5318","authenticated-orcid":false,"given":"Savino","family":"Spadaro","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1828-9143","authenticated-orcid":false,"given":"Salvatore Maurizio","family":"Maggiore","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100 Chieti, Italy"},{"name":"Department of Innovative Technologies in Medicine and Dentistry, Gabriele d\u2019Annunzio University of Chieti Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Bassi","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Venezia Giulia, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Tascini","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy"},{"name":"Department of Medical Area, University of Udine, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Patruno","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Department of Cardio-Thoracic Surgery, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"COVIMIX-STUDY Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1513\/AnnalsATS.202008-1080OC","article-title":"Noninvasive Ventilatory Support of Patients with COVID-19 outside the Intensive Care Units (WARd-COVID)","volume":"18","author":"Bellani","year":"2021","journal-title":"Ann. 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