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Objective.To report the high incidence of barotrauma in critically ill patients admitted to the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19) and to discuss its implications.Design.Retrospective cohort study.Setting.ICU of an academic county hospital in Los Angeles, CA admitted from March 15-June 20, 2020.Patients.77 patients with COVID-19 pneumonia. 75 patients met inclusion criteria.Results.21% of patients with severe COVID-19 sustained barotrauma (33% of patients receiving IMV, 8% of patients receiving (NIV). There were no differences between the barotrauma and non-barotrauma groups regarding demographics, illness severity, or medications received, nor tidal volume or average/peak airway pressures in those receiving IMV. In the barotrauma group there was a greater proportion of patients receiving therapeutic anticoagulation (81% vs. 47%, p = 0.023) and ventilated using airway pressure release ventilation mode (13% vs. 0%, p = 0.043). Barotrauma was associated with increased likelihood of receiving a tracheostomy (OR 2.58 [0.23-4.9], p = 0.018]), longer median ICU length of stay (17 days vs. 7 days, p = 0.03), and longer median length of hospitalization (26 days vs. 14 days, p < 0.001). There was also a trend toward prolonged median duration of IMV (12.5 days vs 7 days, p = 0.13) and higher average mortality (56% vs 37%, p = 0.25).Conclusions.Barotrauma is seen in 5-12% of patients with ARDS receiving IMV and is exceedingly rare in patients receiving NIV. We report a high incidence of barotrauma observed in critically ill patients with COVID-19 requiring either NIV or IMV. While there was a trend toward increased mortality in patients with barotrauma, this did not reach statistical significance. The increased incidence of barotrauma with COVID-19 may be a product of the pathophysiology of this disease state and a heightened inflammatory response causing rampant acute lung injury. Evidence-based medicine and lung-protective ventilation should remain the mainstay of treatment.

The combination of ultrasound and microbubbles allows treatment of indications that would be impossible or too risk adverse with conventional surgery. During treatment, subharmonic and ultraharmonic components that can only be generated from microbubbles are of great interest for intraoperative monitoring. However, the microbubble emissions are several orders of magnitude lower in power compared to that of the fundamental frequency component from the ultrasound applicator, resulting in a low signal‐to‐noise ratio (SNR) for monitoring. A 3D acoustic metamaterial (AMM) immersed in water is proposed for suppressing unwanted ultrasound waves, which allows the improved sensitivity for detecting weak microbubble emissions. Numerically, the importance of shear waves on the AMM transfer properties is highlighted, though only longitudinal ultrasound waves are transmitted through water. Experimentally, the design is implemented in titanium using additive manufacturing, with an attenuation level of 40 dB at the fundamental frequency. Consequently, the application of the AMM efficiently improves the SNR for subharmonic and ultraharmonic microbubble emissions by 11.8 and 11.9 dB, respectively. The subharmonic components originally overwhelmed by noise are recovered. This is the first time that AMMs have been applied to passive acoustic monitoring and this work stands to improve treatment outcomes from cavitation‐mediated focused ultrasound therapy. [ABSTRACT FROM AUTHOR]