Year: 2020
Type: article
Study design: Case Report
Abstract: A 50-year-old man who tested positive for SARS-CoV-2 presented with fever and shortness of breath. He had severe hypoxaemia [fraction of inspired oxygen (FiO2) 1.0] requiring high-flow nasal cannula. Echocardiography was performed with the patient in the left lateral decubitus (LLD) and prone positions. In the LLD position, FiO2 was 0.9 and oxygen saturation on pulse oximetry (spO2) was 93%. Focused images of the right ventricle were used for assessment of right ventricular (RV) longitudinal strain, and tricuspid regurgitation was obtained for evaluation of pulmonary artery systolic pressure (PASP) (Panels A and B). The patient was then imaged from the prone position, increasing his spO2 to 97%. RV strain improved from –23% in the LLD position to –26% in the prone position, and PASP decreased from 51 mmHg to 37 mmHg (Panels C and D). Owing to refractory hypoxaemia with a partial pressure of oxygen/FiO2 (PaO2/FiO2) ratio <100, the patient was mechanically ventilated and ultimately started on veno-venous extracorporeal membrane oxygenation. The echocardiogram was scanned in the prone position with FiO2 0.6 and spO2 96%, showing a small improvement in RV function and no improvement in RV systolic pressure (RVSP) compared with being scanned supine (Panels E and F). RV dysfunction is common in patients with severe acute respiratory distress syndrome, and proning has been shown to improve RV function by transoesophageal echocardiogram. Recently, RV strain has been shown to predict mortality in SARS-CoV-2 infection. Imaging patients in a prone position to obtain non-invasive data is feasible, and the haemodynamic changes are demonstrated within the images. Conflict of interest: none declared.
Authors: Emily Tanel, Sarah Roemer, Pedro Salinas, Bijoy K Khandheria
Institution: Aurora St. Luke's Medical Center
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3027849146