OBJECTIVE: 

There are concerns of a high barotrauma rate in coronavirus disease 2019 patients with acute respiratory distress syndrome receiving invasive mechanical ventilation. However, a few studies were published, and reported rates were highly variable. We performed a systematic literature review to identify rates of barotrauma, pneumothorax, and pneumomediastinum in coronavirus disease 2019 acute respiratory distress syndrome patients receiving invasive mechanical ventilation.

DATA SOURCE: 

PubMed and Scopus were searched for studies reporting barotrauma event rate in adult coronavirus disease 2019 patients receiving invasive mechanical ventilation.

STUDY SELECTION: 

We included all studies investigating adult patients with coronavirus disease 2019 acute respiratory distress syndrome requiring mechanical ventilation. Case reports, studies performed outside ICU setting, and pediatric studies were excluded. Two investigators independently screened and selected studies for inclusion.

DATA EXTRACTION: 

Two investigators abstracted data on study characteristics, rate of pneumothorax, pneumomediastinum and overall barotrauma events, and mortality. When available, data from noncoronavirus disease 2019 acute respiratory distress syndrome patients were also collected. Pooled estimates for barotrauma, pneumothorax, and pneumomediastinum were calculated.

DATA SYNTHESIS: 

A total of 13 studies with 1,814 invasively ventilated coronavirus disease 2019 patients and 493 noncoronavirus disease 2019 patients were included. A total of 266/1,814 patients (14.7%) had at least one barotrauma event (pooled estimates, 16.1% [95% CI, 11.8–20.4%]). Pneumothorax occurred in 132/1,435 patients (pooled estimates, 10.7%; 95% CI, 6.7–14.7%), whereas pneumomediastinum occurred in 162/1,432 patients (pooled estimates, 11.2%; 95% CI, 8.0–14.3%). Mortality in coronavirus disease 2019 patients who developed barotrauma was 111/198 patients (pooled estimates, 61.6%; 95% CI, 50.2–73.0%). In noncoronavirus disease 2019 acute respiratory distress syndrome patients, barotrauma occurred in 31/493 patients (6.3%; pooled estimates, 5.7%; 95% CI, −2.1% to 13.5%).

CONCLUSIONS: 

Barotrauma occurs in one out of six coronavirus disease 2019 acute respiratory distress syndrome patients receiving invasive mechanical ventilation and is associated with a mortality rate of about 60%. Barotrauma rate may be higher than noncoronavirus disease 2019 controls.

中文翻译：

---

接受有创机械通气的 2019 冠状病毒病患者的气压伤：系统文献综述*

 客观的：

人们担心接受有创机械通气的 2019 冠状病毒病患有急性呼吸窘迫综合征的患者气压伤发生率较高。然而，已经发表了一些研究，并且报告的比率差异很大。我们进行了系统性文献综述，以确定接受有创机械通气的 2019 冠状病毒病急性呼吸窘迫综合征患者的气压伤、气胸和纵隔气肿发生率。

 数据来源：

PubMed 和 Scopus 搜索了报告接受有创机械通气的 2019 年冠状病毒病成人患者气压伤事件发生率的研究。

 研究选择：

我们纳入了所有调查需要机械通气的 2019 年冠状病毒病急性呼吸窘迫综合征成年患者的研究。病例报告、在 ICU 环境之外进行的研究以及儿科研究被排除在外。两名研究人员独立筛选并选择纳入的研究。

 数据提取：

两名研究人员提取了有关研究特征、气胸、纵隔气肿和总体气压伤事件以及死亡率的数据。如果有的话，还收集了 2019 年非冠状病毒疾病急性呼吸窘迫综合征患者的数据。计算了气压伤、气胸和纵隔气肿的汇总估计值。

 数据综合：

共纳入 13 项研究，涉及 1,814 名有创通气 2019 年冠状病毒病患者和 493 名非 2019 年冠状病毒病患者。总共 266/1,814 名患者 (14.7%) 至少发生过一次气压伤事件（汇总估计为 16.1% [95% CI, 11.8–20.4%]）。气胸发生在 132/1,435 例患者中（汇总估计值为 10.7%；95% CI，6.7–14.7%），而纵隔气肿发生在 162/1,432 例患者中（汇总估计值为 11.2%；95% CI，8.0–14.3%）。 2019 年冠状病毒病发生气压伤的患者死亡率为 111/198（汇总估计为 61.6%；95% CI，50.2-73.0%）。在 2019 年非冠状病毒疾病急性呼吸窘迫综合征患者中，31/493 名患者发生气压伤（6.3%；汇总估计为 5.7%；95% CI，-2.1% 至 13.5%）。

 结论：

接受有创机械通气的 2019 冠状病毒病急性呼吸窘迫综合征患者中，有六分之一会发生气压伤，死亡率约为 60%。气压伤发生率可能高于 2019 年非冠状病毒疾病对照。