Critical care ultrasonography during COVID-19 pandemic: The ORACLE protocol
Critical care ultrasonography during COVID-19 pandemic: The ORACLE protocol
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DOI：
10.1111/echo.14837
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发表时间：
2020-08-29
影响因子：
1.5
通讯作者：
Baranda-Tovar, Francisco
中科院分区：
文献类型：
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作者：
Garcia-Cruz, Edgar;Manzur-Sandoval, Daniel;Baranda-Tovar, Francisco
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。重症监护超声检查至关重要，因为它为诊断和治疗提供了实时信息。建议的图像采集和测量方案尚未得到评价。方法于2020年4月1日至2020年5月30日在两个中心对重症监护病房确诊的成年COVID-19感染患者进行横断面研究。使用专为本研究设计的ORACLE方案进行心肺评估，以确保结构化的图像采集过程并限制工作人员接触感染。结果对82例连续住院患者进行评价。患者以男性居多，中位年龄56岁，最常见的合并症为高血压和2型糖尿病，25%的患者有严重急性呼吸窘迫综合征。最常见的超声表现为肺动脉收缩压升高（69.5%），E/ E比值bbb14(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率（82.9%）。肺超声的中位评分（19分）在两组之间没有任何差异。肺动脉收缩压升高与较高的住院死亡率相关。结论ORACLE方案是一种可行、快速、安全的新冠肺炎患者血液动力学和呼吸评估床边工具。应进一步研究肺血流动力学和右心室功能的改变及其与预后的关系。
Background 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. Methods 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. Results 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. Conclusion 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.