Ventilator management and risk of air leak syndrome for patients with COVID-19 pneumonia: a single-center, retrospective, observational study

Abstract Background: Coronavirus disease 2019 (COVID-19) pneumonia is reportedly associated with air leak syndrome (ALS), including mediastinal emphysema and pneumothorax, and has a high mortality rate. In this study, we compared values obtained every minute from ventilators to clarify the relationship between ventilator management (VM) and risk of developing ALS. Methods This single-center, retrospective, observational study took place at a tertiary care hospital in Tokyo, Japan, over a 21-month period. Patient background, ventilator data, and outcomes were collected from adult patients with COVID-19 pneumonia on VM. Patients who developed ALS within 30 days of VM initiation (ALS group) were compared with those who did not (non-ALS group). Results: Of the 105 patients, 14 (13%) developed ALS. The mean positive-end expiratory pressure (PEEP) difference was 0.33 cmH2O (95% confidence interval [CI], 0.31 to 0.33), and was higher in the ALS than in the non-ALS group (9.18 ± 2.20 vs. 8.85 ± 2.63, respectively). For peak pressure, the mean difference was − 0.18 cmH2O (95% CI, -0.20 to -0.15) (20.70 ± 5.30 in ALS vs. 20.87 ± 5.65 in non-ALS group) and the mean pressure difference of -0.05 cmH2O (95% CI, -0.04 to -0.07) (12.80 ± 3.13 vs. 12.85 ± 3.55, respectively) was also higher in the non-ALS group. The difference in single ventilation volume per ideal body weight was 0.65 mL/kg (95% CI, 0.63 to 0.66) (7.83 ± 3.16 vs. 7.18 ± 2.96, respectively), and the difference in dynamic lung compliance was 8.57 mL/cmH2O (95% CI, 8.43 to 8.70) (50.32 ± 31.68 vs. 49.68 ± 15.16, respectively); both were higher in the ALS group. Conclusions: There was no association between higher ventilator pressures and the development of ALS. The ALS group had higher dynamic lung compliance and higher tidal volumes, which may indicate a pulmonary contribution to ALS. VM that limits tidal volume may prevent the development of ALS.