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

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

Research output: Contribution to journalArticle in an indexed scientific journalpeer-review

201 Scopus citations

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.

Original languageEnglish
Pages (from-to)612-619
Number of pages8
JournalIntensive Care Medicine
Volume30
Issue number4
DOIs
StatePublished - Apr 2004
Externally publishedYes

Bibliographical note

Funding Information:
Acknowledgements The list of members of the Mechanical Ventilation Study Group is available in the electronic link. This study was supported in part by grant 98/0233 from the Fondo de Investigación Sanitaria, Health Ministry of Spain and Red GIRA and Red RESPIRA, Instituto de Salud Carlos III, Spain.

Keywords

  • ARDS
  • Barotrauma
  • Mechanical
  • PEEP
  • Pneumothorax
  • Tidal volume
  • Ventilation

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