{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:48:21Z","timestamp":1777312101774,"version":"3.51.4"},"reference-count":62,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024]]},"abstract":"<jats:p>Introduction: Pulmonary barotrauma in coronavirus disease-2019 (COVID-19) acute respiratory distress syndrome (ARDS) carries high risk of mortality. While various studies have reported increased mortality, few have assessed the contributing factors for the occurrence of this complication. This study aimed at exploring the contributing factors for barotrauma in COVID-19 ARDS.<\/jats:p>\n                  <jats:p>Methodology: In this retrospective study, patients aged \u226518 years with laboratory confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by reverse transcriptase polymerase chain reaction (RT-PCR) from a nasopharyngeal swab and having severe or critical COVID-19 disease requiring Intensive Care Unit (ICU) admission according to the World Health Organisation (WHO) criteria for disease severity in COVID-19 disease admitted at forty-bedded ICUs at a tertiary care research hospital in North India from April 1, 2020, to March 31, 2022 were included.<\/jats:p>\n                  <jats:p>\n                    Results: Of 825 patients admitted to COVID ICU, 40 developed pulmonary barotrauma, with a mortality rate of 85%. The mean \u00b1 SD PaO\n                    <jats:sub>2<\/jats:sub>\n                    \/FiO\n                    <jats:sub>2<\/jats:sub>\n                    was 96.76 \u00b1 27.78 mmHg. Thirty-nine patients received steroids, 37 developed secondary bacterial infection of the lower respiratory tract with one or more organisms.\n                    <jats:italic>Acinetobacter baumannii<\/jats:italic>\n                    (\n                    <jats:italic>n<\/jats:italic>\n                    = 15),\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    (\n                    <jats:italic>n<\/jats:italic>\n                    = 10), and\n                    <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                    (\n                    <jats:italic>n<\/jats:italic>\n                    = 8) were the commonest isolates. Ten patients developed pneumomediastinum, of which 6 patients had subcutaneous emphysema along with pneumomediastinum, and 2 patients developed isolated subcutaneous emphysema. The remaining 28 patients developed pneumothorax.\n                  <\/jats:p>\n                  <jats:p>\n                    The mean (\u00b1SD) for static respiratory system compliance (Crs) for patients on mechanical ventilation on the day of barotrauma was 19.3 (\u00b110.5) mL\/cmH\n                    <jats:sub>2<\/jats:sub>\n                    O.\n                  <\/jats:p>\n                  <jats:p>Conclusion: Patients with COVID-19 ARDS developing pulmonary barotrauma have a high associated mortality, and secondary bacterial infection, lung fragility, patient-ventilator asynchrony, as well as low respiratory system compliance, may contribute to lung injury, predisposing to barotrauma.<\/jats:p>","DOI":"10.5339\/qmj.2024.64","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T03:50:43Z","timestamp":1736394643000},"source":"Crossref","is-referenced-by-count":0,"title":["Characteristics and outcomes of pulmonary barotrauma in patients with COVID-19 ARDS: A retrospective observational study"],"prefix":"10.5339","volume":"2024","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5915-3608","authenticated-orcid":true,"given":"Varun","family":"Mahajan","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamal","family":"Kajal","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6563-1477","authenticated-orcid":true,"given":"Amarjyoti","family":"Hazarika","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karan","family":"Singla","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3868-0473","authenticated-orcid":true,"given":"Naveen","family":"Naik B","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7175-6775","authenticated-orcid":true,"given":"Ananya","family":"Ray","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, BR Ambedkar Institute of Medical Sciences, Mohali, Punjab, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8265-5198","authenticated-orcid":true,"given":"Venkata","family":"Ganesh","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajay","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5210-1012","authenticated-orcid":true,"given":"Ashish","family":"Bhalla","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India*Correspondence: Ananya Ray ananyaray1812@hotmail.com"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9763-4055","authenticated-orcid":true,"given":"Goverdhan Dutt","family":"Puri","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3277","reference":[{"key":"CIT0001","series-title":"Clin Imaging","first-page":"71\u20137","article-title":"Barotrauma in COVID 19: Incidence, pathophysiology, and effect on prognosis","volume":"90","author":"Steinberger\n \nS","year":"2022;"},{"key":"CIT0002","article-title":"Physiology, transpulmonary pressure","author":"Neupane\n \nK","year":"2024"},{"issue":"(1):","key":"CIT0003","series-title":"J Appl Physiol","first-page":"15\u201329","article-title":"Mechanisms in development of interstitial emphysema and air embolism on decompression from 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\nVM","year":"2012;"},{"issue":"(1):","key":"CIT0008","series-title":"Am J Respir Crit Care Med","first-page":"52\u20139","article-title":"Hospital incidence and outcomes of the acute respiratory distress syndrome using the Kigali Modification of the Berlin Definition","volume":"193","author":"Riviello\n \nED","year":"2016;"},{"key":"CIT0009","series-title":"Ann Med Surg (Lond)","first-page":"103221","article-title":"Pulmonary barotrauma in COVID-19: A systematic review and meta-analysis","volume":"73","author":"Shrestha\n \nDB","year":"2022;"},{"issue":"(1):","key":"CIT0010","series-title":"BMC Anesthesiol","first-page":"138","article-title":"Barotrauma in COVID-19 acute respiratory distress syndrome: Retrospective analysis of the COVADIS prospective multicenter observational database","volume":"23","author":"Serck\n \nN","year":"2023;"},{"issue":"(3):","key":"CIT0011","series-title":"Crit Care Med","first-page":"491\u2013500","article-title":"Barotrauma in coronavirus disease 2019 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\nA","year":"2022;"},{"issue":"(1):","key":"CIT0019","series-title":"Crit Care","first-page":"154","article-title":"Prone positioning improves ventilation-perfusion matching assessed by electrical impedance tomography in patients with ARDS: A prospective physiological study","volume":"26","author":"Wang\n \nYX","year":"2022;"},{"issue":"(17):","key":"CIT0020","series-title":"N Engl J Med","first-page":"1775\u201386","article-title":"Lung recruitment in patients with the acute respiratory distress syndrome","volume":"354","author":"Gattinoni\n \nL","year":"2006;"},{"issue":"(3):","key":"CIT0021","series-title":"Qatar Med J","first-page":"62","article-title":"Bacterial coinfections and secondary infections in COVID-19 patients from a tertiary care hospital of northern India: Time to adhere to culture-based practices","volume":"2021","author":"Sharma\n \nB","year":"2021;"},{"issue":"(1):","key":"CIT0022","series-title":"Ann Intensive Care","first-page":"119","article-title":"Bacterial and 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\nV","year":"2006;"},{"issue":"(67):","key":"CIT0026","series-title":"Sci Immunol","first-page":"eabm5505","article-title":"Innate immunological pathways in COVID-19 pathogenesis","volume":"7","author":"Paludan\n \nSR","year":"2022;"},{"issue":"(11):","key":"CIT0027","series-title":"Respir Care","first-page":"1773\u201394","article-title":"Respiratory mechanics in mechanically ventilated patients","volume":"59","author":"Hess\n \nDR","year":"2014;"},{"key":"CIT0028","article-title":"Physiology, airflow resistance","author":"Campbell\n \nM","year":"2024"},{"issue":"(2):","key":"CIT0029","series-title":"Chest","first-page":"568\u201372","article-title":"Pulmonary barotrauma in mechanical ventilation. Patterns and risk factors","volume":"102","author":"Gammon\n \nRB","year":"1992;"},{"issue":"(7):","key":"CIT0030","series-title":"Am J Respir Crit Care Med","first-page":"978\u201382","article-title":"Airway pressures and early barotrauma in patients with acute lung injury and acute respiratory distress syndrome","volume":"165","author":"Eisner\n \nMD","year":"2002;"},{"issue":"(4):","key":"CIT0031","series-title":"ERJ Open Res","first-page":"00385-2020","article-title":"Pneumomediastinum and subcutaneous emphysema in COVID-19: Barotrauma or lung frailty?","volume":"6","author":"Lemmers\n \nDHL","year":"2020;"},{"key":"CIT0001","series-title":"Clin Imaging","first-page":"71\u20137","article-title":"Barotrauma in COVID 19: Incidence, pathophysiology, and effect on prognosis","volume":"90","author":"Steinberger\n \nS","year":"2022;"},{"key":"CIT0002","article-title":"Physiology, transpulmonary pressure","author":"Neupane\n \nK","year":"2024"},{"issue":"(1):","key":"CIT0003","series-title":"J Appl Physiol","first-page":"15\u201329","article-title":"Mechanisms in development of interstitial emphysema and air embolism on decompression from depth","volume":"13","author":"Schaffer\n \nKE","year":"1958;"},{"issue":"(18):","key":"CIT0004","series-title":"N Engl J Med","first-page":"1301\u20138","article-title":"Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome","volume":"342","author":"Brower\n \nRG","year":"2000;"},{"issue":"(2):","key":"CIT0005","series-title":"Radiology","first-page":"E252\u2013E62","article-title":"Increased incidence of barotrauma in patients with COVID-19 on invasive mechanical ventilation","volume":"297","author":"McGuinness\n \nG","year":"2020;"},{"key":"CIT0006","article-title":"Living guidance for clinical management of COVID-19: World Health Organization","year":"2021"},{"issue":"(23):","key":"CIT0007","series-title":"JAMA","first-page":"2526\u201333","article-title":"Acute respiratory distress syndrome: The Berlin Definition","volume":"307","author":"Ranieri\n \nVM","year":"2012;"},{"issue":"(1):","key":"CIT0008","series-title":"Am J Respir Crit Care Med","first-page":"52\u20139","article-title":"Hospital incidence and outcomes of the acute respiratory distress syndrome using the Kigali Modification of the Berlin Definition","volume":"193","author":"Riviello\n \nED","year":"2016;"},{"key":"CIT0009","series-title":"Ann Med Surg (Lond)","first-page":"103221","article-title":"Pulmonary barotrauma in COVID-19: A systematic review and meta-analysis","volume":"73","author":"Shrestha\n \nDB","year":"2022;"},{"issue":"(1):","key":"CIT0010","series-title":"BMC Anesthesiol","first-page":"138","article-title":"Barotrauma in COVID-19 acute respiratory distress syndrome: Retrospective analysis of the COVADIS prospective multicenter observational database","volume":"23","author":"Serck\n \nN","year":"2023;"},{"issue":"(3):","key":"CIT0011","series-title":"Crit Care Med","first-page":"491\u2013500","article-title":"Barotrauma in coronavirus disease 2019 patients undergoing invasive mechanical ventilation: A systematic literature review","volume":"50","author":"Belletti\n \nA","year":"2022;"},{"issue":"(9):","key":"CIT0012","series-title":"J Intensive Care Med","first-page":"1013\u20137","article-title":"Pulmonary barotrauma in COVID-19 patients with ARDS on invasive and non-invasive positive pressure ventilation","volume":"36","author":"Rajdev\n \nK","year":"2021;"},{"issue":"(6):","key":"CIT0013","series-title":"Cureus","first-page":"e26414","article-title":"Pulmonary barotrauma in COVID-19 patients: Experience from a secondary care hospital in Oman","volume":"14","author":"Kajenthiran\n \nR","year":"2022;"},{"key":"CIT0014","series-title":"Int J Gen Med","first-page":"2017\u201332","article-title":"Pulmonary barotrauma in COVID-19 patients: Invasive versus noninvasive positive pressure ventilation","volume":"14","author":"Hamouri\n \nS","year":"2021;"},{"issue":"(1):","key":"CIT0015","series-title":"BMC Anesthesiol","first-page":"138","article-title":"Barotrauma in COVID-19 acute respiratory distress syndrome: Retrospective analysis of the COVADIS prospective multicenter observational database","volume":"23","author":"Serck\n \nN","year":"2023;"},{"issue":"(1):","key":"CIT0016","series-title":"Bull Natl Res Cent","first-page":"212","article-title":"Barotrauma and its complications in COVID-19 patients: A retrospective study at tertiary care hospital of Eastern India","volume":"46","author":"Dubey\n \nR","year":"2022;"},{"issue":"(1):","key":"CIT0017","series-title":"Crit Care","first-page":"339","article-title":"COVID-19 targets the right lung","volume":"24","author":"Li\n \nJ","year":"2020;"},{"key":"CIT0018","series-title":"Trends Anaesth Crit Care","first-page":"11\u20136","article-title":"Effect of head-end of bed elevation on respiratory mechanics in mechanically ventilated patients with moderate-to-severe COVID-19 ARDS - A cohort study","volume":"43","author":"Ray\n \nA","year":"2022;"},{"issue":"(1):","key":"CIT0019","series-title":"Crit Care","first-page":"154","article-title":"Prone positioning improves ventilation-perfusion matching assessed by electrical impedance tomography in patients with ARDS: A prospective physiological study","volume":"26","author":"Wang\n \nYX","year":"2022;"},{"issue":"(17):","key":"CIT0020","series-title":"N Engl J Med","first-page":"1775\u201386","article-title":"Lung recruitment in patients with the acute respiratory distress syndrome","volume":"354","author":"Gattinoni\n \nL","year":"2006;"},{"issue":"(3):","key":"CIT0021","series-title":"Qatar Med J","first-page":"62","article-title":"Bacterial coinfections and secondary infections in COVID-19 patients from a tertiary care hospital of 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Virol","first-page":"1629\u201336","article-title":"Respiratory viruses augment the adhesion of bacterial pathogens to respiratory epithelium in a viral species- and cell type-dependent manner","volume":"80","author":"Avadhanula\n \nV","year":"2006;"},{"issue":"(67):","key":"CIT0026","series-title":"Sci Immunol","first-page":"eabm5505","article-title":"Innate immunological pathways in COVID-19 pathogenesis","volume":"7","author":"Paludan\n \nSR","year":"2022;"},{"issue":"(11):","key":"CIT0027","series-title":"Respir Care","first-page":"1773\u201394","article-title":"Respiratory mechanics in mechanically ventilated patients","volume":"59","author":"Hess\n \nDR","year":"2014;"},{"key":"CIT0028","article-title":"Physiology, airflow resistance","author":"Campbell\n \nM","year":"2024"},{"issue":"(2):","key":"CIT0029","series-title":"Chest","first-page":"568\u201372","article-title":"Pulmonary barotrauma in mechanical ventilation. 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