García-Cruz Edgar, Manzur-Sandoval Daniel, Rascón-Sabido Rafael, Gopar-Nieto Rodrigo, Barajas-Campos Ricardo Leopoldo, Jordán-Ríos Antonio, Sierra-Lara Martínez Daniel, Jiménez-Rodríguez Gian Manuel, Murillo-Ochoa Adriana Lizeth, Díaz-Méndez Arturo, Lazcano-Díaz Emmanuel, Araiza-Garaygordobil Diego, Cabello-López Alejandro, Melano-Carranza Efrén, Bucio-Reta Eduardo, González-Ruiz Francisco Javier, Cota-Apodaca Luis Antonio, Santos-Martínez Luis Efrén, Fernández-de la Reguera Guillermo, Ramos-Enríquez Ángel, Rojas-Velasco Gustavo, Álvarez-Álvarez Rolando Joel, Baranda-Tovar Francisco
Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
Heart Failure Service, Hospital Naval de Especialidades Veracruz, Veracruz, Mexico.
Echocardiography. 2020 Sep;37(9):1353-1361. doi: 10.1111/echo.14837. Epub 2020 Aug 29.
Coronavirus disease 2019 (COVID-19) is characterized by severe lung involvement and hemodynamic alterations. Critical care ultrasonography is vital because it provides real time information for diagnosis and treatment. Suggested protocols for image acquisition and measurements have not yet been evaluated.
This cross-sectional study was conducted at two centers from 1 April 2020 to 30 May 2020 in adult patients with confirmed COVID-19 infection admitted to the critical care unit. Cardiac and pulmonary evaluations were performed using the ORACLE protocol, specifically designed for this study, to ensure a structured process of image acquisition and limit staff exposure to the infection.
Eighty-two consecutively admitted patients were evaluated. Most of the patients were males, with a median age of 56 years, and the most frequent comorbidities were hypertension and type 2 diabetes, and 25% of the patients had severe acute respiratory distress syndrome. The most frequent ultrasonographic findings were elevated pulmonary artery systolic pressure (69.5%), E/e' ratio > 14 (29.3%), and right ventricular dilatation (28%) and dysfunction (26.8%). A high rate of fluid responsiveness (82.9%) was observed. The median score (19 points) on pulmonary ultrasound did not reveal any variation between the groups. Elevated pulmonary artery systolic pressure was associated with higher in-hospital mortality.
The ORACLE protocol was a feasible, rapid, and safe bedside tool for hemodynamic and respiratory evaluation of patients with COVID-19. Further studies should be performed on the alteration in pulmonary hemodynamics and right ventricular function and its relationship with outcomes.
2019冠状病毒病（COVID-19）的特征是严重的肺部受累和血流动力学改变。重症超声检查至关重要，因为它可为诊断和治疗提供实时信息。图像采集和测量的建议方案尚未得到评估。
这项横断面研究于2020年4月1日至2020年5月30日在两个中心对入住重症监护病房的确诊COVID-19感染成年患者进行。使用专门为本研究设计的ORACLE方案进行心脏和肺部评估，以确保图像采集过程结构化，并限制工作人员接触感染源。
对82例连续入院的患者进行了评估。大多数患者为男性，中位年龄为56岁，最常见的合并症是高血压和2型糖尿病，25%的患者患有严重急性呼吸窘迫综合征。最常见的超声检查结果是肺动脉收缩压升高（69.5%）、E/e'比值>14（29.3%）、右心室扩张（28%）和功能障碍（26.8%）。观察到较高的液体反应性（82.9%）。肺部超声的中位评分（19分）在各组之间未显示出任何差异。肺动脉收缩压升高与较高的院内死亡率相关。
ORACLE方案是一种用于COVID-19患者血流动力学和呼吸评估的可行、快速且安全的床旁工具。应进一步研究肺部血流动力学和右心室功能的改变及其与预后的关系。
