Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients.
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.


METHODS
Prospective cohort of 361 intensive care units from 20 countries.


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


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 increase in the ICU length of stay and mortality.
Department of Medicine, Division of Pulmonary /Critical Care Medicine, University of Texas Health Science Center and South Texas Veterans Health Care System, Audie L. Murphy Memorial Veterans Hospital Division, San Antonio, TX USA. anzueto@uthscsa.edu
Antonio
A
Anzueto
Fernando
F
Frutos-Vivar
Andres
A
Esteban
Inmaculada
I
Alía
Laurent
L
Brochard
Thomas
T
Stewart
Salvador
S
Benito
Martin J
MJ
Tobin
Jose
J
Elizalde
Fernando
F
Palizas
Cide M
CM
David
Jorge
J
Pimentel
Marco
M
González
Luis
L
Soto
Gabriel
G
D'Empaire
Paolo
P
Pelosi
D000328:Adult; D000368:Aged; D001249:Asthma / Q000473:pathology / Q000628:therapy; D001469:Barotrauma / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000473:pathology / Q000628:therapy; D012121:Respiration, Artificial / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000473:pathology / Q000628:therapy; D012307:Risk Factors; D015996:Survival Rate