New WVU study finds high rates of complication in patients admitted to ICU with COVID-19

Since early 2020 COVID-19 has claimed the lives of more than one million Americans with close to 8,000 of those deaths in West Virginia.

As hospitals throughout the country worked around the clock to treat patients with moderate and severe cases of COVID-19, physicians on the WVU Medicine Medical Intensive Care Unit (MICU) team were noticing a complication in several COVID-19 patients with ARDS : barotrauma

Acute respiratory distress syndrome, also known as ARDS, is most commonly seen as a complication of the flu or sepsis and usually happens with patients who are severely sick. A dreaded known complication of ARDS patients who are intubated is barotrauma. This has largerly been minimized with newer ventilatory techniques involving low volume breaths (ARDS net protocol). During the pandemic ARDS was often seen as a complication to COVID-19 pneumonia. However, the Medical ICU team at WVU noticed much higer rates of barotrauma despite use of lung protective strategies. Furthermore, the team noticed patients being treated for COVID-19 without intubation were also experiencing this complication in high rates.

“Because there are few tertiary hospitals and extensive ICU capabilities in West Virginia, many patients were being sent to WVU Medicine’s MICU in later stages of COVID-19 and were already experiencing ARDS,” said Sunil Sharma, M.D., medical director of the MICU and section chief and professor in the Department of Medicine’s Section of Pulmonary Critical Care and Sleep Medicine.

This finding is the focus of several WVU Medicine physicians’ study “High incidence of barotrauma in patients admitted with COVID-19 to ICU and associated mortality in rural Appalachia: An observational study” recently published in the PLOS One journal.

“The study was designed to look at patients admitted to the ICU with COVID-19 and ARDS compared to patients experiencing ARDS in the past without COVID-19,” said Dr. Sharma. “We found double the amount of barotrauma incidence in patients who were experiencing ARDS due to COVID-19 compared to patients with ARDS in the pre-covid era. The higher incidence was also associated with higher mortality and increased length of stay in both the ICU and the hospital.

While this correlation wasn’t obvious at first, Sharma explains that it is likely many cases of ARDS in patients with COVID-19 went undiagnosed due to limited resources and knowledge at the onset of COVID-19.

“While there are several resources and past experiences treating ARDS cases, the prevalence of the disease with COVID-19 didn’t follow the same rules we have seen previously, making it harder to notice early on and treat once diagnosed,” Sharma said.

This is especially true for rural areas such as those in West Virginia where limited access and far distances can make it difficult to attain access to extensive care.

“With how devastating COVID-19 and ARDS was, we needed specific data for West Virginia instead of just following literature from other places,” said Sharma. “We needed to be more aware of local dynamics and this study is a step in that direction.”

Sharma hopes that the findings from this study inform physicians in a variety of specialties taking care of COVID-19 peumonia and ARDS of the potential of barotrauma. According to Sharma, increased awareness and early detection of barotrauma can lead to better patient outcomes when needing to be transferred to tertiary care. Furthermore this complication can occur in non-ventilated patients and hence physicians taking care of COVID-19 patients on the general floor also need to be aware of it.

Sharma believes the next step is to collaborate with scientists on studies to further understand how barotrauma in the lungs is caused by COVID-19 and ARDS. These findings are necessary to provide the best care for patients across West Virginia and the surrounding region.

“Understanding the unique dynamics of healthcare in West Virginia and rural communities is important for decreasing the health disparities in the state.”

To learn more about the Section of Pulmonary Critical Care and Sleep Medicine visit medicine.hsc.wvu.edu/medicine/sections-of-medicine/pulmonary-critical-care-and-sleep-medicine/.

To learn more about WVU Medicine’s Medical Intensive Care Unit visit wvumedicine.org/criticalcare/medical-intensive-care-unit-micu/.