Poor Hooman, Abassi Adeel, Howell Daniel, Reynolds Alexandra, Reilly-Kit Kaitlin, Rurak Kevin, Cohen Maya, Baird Grayson, Worst Lilian, Shin Elizabeth, Yu Paul, Lee Alison, Ventetuolo Corey E
Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
BMJ Open Respir Res. 2025 Sep 3;12(1):e002912. doi: 10.1136/bmjresp-2024-002912.
We previously demonstrated a high prevalence of transpulmonary bubble transit (TPBT) using transcranial Doppler (TCD) in patients with COVID-19 pneumonia, but these observations require confirmation.
Patients at two academic medical centres, hospitalised with COVID-19 pneumonia and requiring any form of respiratory support, were studied. The first TCD study was performed at the time of enrolment and repeated approximately 7 and 14 days later if participants remained hospitalised.
91 participants were enrolled. At the first TCD, 14 participants (15%) were receiving oxygen by nasal cannula, 41 participants (45%) were receiving oxygen by high flow nasal cannula, 8 participants (9%) were receiving non-invasive positive pressure, 28 participants (31%) were receiving mechanical ventilation and 2 participants (2%) were receiving extracorporeal membrane oxygenation. 33 participants (36%) demonstrated TPBT at the first TCD. There was evidence that the presence of TPBT and increased heart rate together was associated with in-hospital death (p=0.02). For every one-unit increase in heart rate, the odds of death increased 11% (OR 1.11, 95% CI 1.02 to 1.20, p=0.01) for those with TPBT; however, there was no evidence of this increase for those without TPBT (OR 1.01, 95% CI 0.97 to 1.05, p=0.76). For participants with subsequent TCD assessments, 55% demonstrated TPBT during the second TCD assessment, and 85% demonstrated TPBT at the third TCD assessment.
The prevalence of TPBT in hospitalised patients with COVID-19 pneumonia is higher than expected and the presence of TPBT increases over time in those that remained alive and hospitalised. In patients with TPBT, increased heart rate, a marker of hyperdynamic circulation, is associated with increased mortality.
我们之前使用经颅多普勒（TCD）证明了新冠病毒肺炎患者中经肺气泡通过（TPBT）的高发生率，但这些观察结果需要得到证实。
对两家学术医疗中心因新冠病毒肺炎住院且需要任何形式呼吸支持的患者进行了研究。首次TCD研究在入组时进行，如果参与者仍住院，则在大约7天和14天后重复进行。
共纳入91名参与者。在首次TCD检查时，14名参与者（15%）通过鼻导管吸氧，41名参与者（45%）通过高流量鼻导管吸氧，8名参与者（9%）接受无创正压通气，28名参与者（31%）接受机械通气，2名参与者（2%）接受体外膜肺氧合。33名参与者（36%）在首次TCD检查时出现TPBT。有证据表明，TPBT的存在与心率增加共同与院内死亡相关（p=0.02）。对于有TPBT的患者，心率每增加一个单位，死亡几率增加11%（OR 1.11，95%CI 1.02至1.20，p=0.01）；然而，对于没有TPBT的患者，没有证据表明有这种增加（OR 1.01，95%CI 0.97至1.05，p=0.76）。对于进行了后续TCD评估的参与者，55%在第二次TCD评估时出现TPBT，85%在第三次TCD评估时出现TPBT。
新冠病毒肺炎住院患者中TPBT的发生率高于预期，并且在存活并住院的患者中，TPBT的发生率随时间增加。在有TPBT的患者中，心率增加（高动力循环的一个指标）与死亡率增加相关。
