Belligund Pooja, Lee David, Balasubramaniam Mehrala, Khanijao Suchit, Damania Dushyant, Vallumsetla Nishant, Sajawal Qasim, Perez-Gandara Brais, Perez-Perez Jessica, Shalom Isaac, Dubey Gangacharan, Sanghavi Sarah, Lu Chen, Mitre Cristina, Zein Joe, Al-Ajam Mohammad
, , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio.
Fed Pract. 2021 Sep;38(9):396-401. doi: 10.12788/fp.0177. Epub 2021 Sep 12.
During the COVID-19 pandemic, the need for judicious use of diagnostic tests and to limit personnel exposure has led to increased use and dependence on point-of-care ultrasound (POCUS) examinations. We reviewed POCUS findings in patients admitted to the intensive care unit (ICU) for acute respiratory failure with COVID-19 and correlated the findings to severity of illness and 30-day outcomes.
Patients admitted to the ICU in March and April 2020 were reviewed for inclusion (acute hypoxemic respiratory failure secondary to COVID-19 pneumonia; documentation of POCUS findings).
Forty-three patients met inclusion criteria. B lines and pleural thickening were associated with a lower PaO/FiO by 71 ( = .005; adjusted = 0.24). Right ventricle (RV) dilation was more common in patients with 30-day mortality ( = .02) and was a predictor of mortality when adjusted for hypertension, diabetes mellitus, and age (odds ratio, 12.0; = .048). All patients with RV dilation had bilateral B lines with pleural irregularities.
Although lung ultrasound abnormalities are prevalent in patients with severe disease, RV involvement seems to be predictive of outcomes. Further studies are needed to discern the etiology and pathophysiology of RV dilation in COVID-19.
在新冠疫情期间，合理使用诊断检测并限制人员暴露的需求导致即时超声（POCUS）检查的使用和依赖增加。我们回顾了因新冠病毒肺炎导致急性呼吸衰竭而入住重症监护病房（ICU）的患者的POCUS检查结果，并将这些结果与疾病严重程度和30天预后相关联。
对2020年3月和4月入住ICU的患者进行回顾以确定纳入标准（新冠病毒肺炎继发急性低氧性呼吸衰竭；记录POCUS检查结果）。
43例患者符合纳入标准。B线和胸膜增厚与较低的氧合指数（PaO₂/FiO₂）相关，差值为71（P = 0.005；校正后β = 0.24）。右心室（RV）扩张在30天死亡率较高的患者中更为常见（P = 0.02），在调整高血压、糖尿病和年龄后，是死亡率的一个预测因素（比值比，12.0；P = 0.048）。所有右心室扩张的患者均有双侧B线伴胸膜不规则。
虽然肺部超声异常在重症患者中很常见，但右心室受累似乎可预测预后。需要进一步研究以明确新冠病毒肺炎中右心室扩张的病因和病理生理学。
