Trans-thoracic Echocardiography in Prone Positioning COVID-19 Patients: a Small Case Series
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COVID-19
Trans-thoracic Echocardiography in Prone Positioning COVID-19 Patients: a Small Case Series Enrico Giustiniano 1
&
Fabio Fazzari 2 & Renato Maria Bragato 2 & Mirko Curzi 2 & Maurizio Cecconi 1,3
Accepted: 9 September 2020 # Springer Nature Switzerland AG 2020
Abstract During SARS-CoV-2 pandemic, several subjects were treated in our intensive care unit (ICU) because of acute respiratory failure following COVID-19 pneumonia. Most of them required mechanical ventilation and someone in prone position (PP) too, because of acute respiratory distress syndrome (ARDS). During PP, trans-esophageal echocardiography (TEE) is not always easy, mainly due to the forced position of the neck of the patient. Moreover, during a pandemic, given the great number of patients needing treatment, TEE probes and monitoring devices are not widely available. Then, trans-thoracic echocardiography (TTE) plays a crucial role as it is non-invasive, repeatable, and available every time it is needed. Moreover, it can be safely performed also in prone position (TTEp). According to in-hospital protocol, TTEp was performed using the apical-four-chamber (A-4-C) view in 8 patients. We temporarily deflated the lower thoracic section of the air-mattress to place the probe between the mattress surface and the thorax of the patient. We collected both TEE and hemodynamics data. The main result of our retrospective analysis is that TTE can be performed in patients in prone positioning and is reliable and repeatable; the single apicalfour-chamber view provides sufficient data to evaluate the cardiac performance in case of scarce availability of hemodynamic monitoring devices, like in a pandemic setting. TTE may be a helpful tool for cardiac performance evaluation and diagnosis not only in supine or anterolateral positioning like in echocardiographic lab, but also in subjects admitted to ICU due to ARDS needing of mechanical ventilation in prone positioning. Keywords Respiratory failure . Echocardiography . Coronavirus
Introduction During SARS-CoV-2 pandemic, several subjects were treated in our intensive care unit (ICU) because of acute respiratory failure following COVID-19 pneumonia. Most of them required mechanical ventilation (MV) and some of them in prone position (PP) too, because of acute respiratory distress syndrome (ARDS), trying to re-open the collapsed and wet This article is part of the Topical Collection on COVID-19 * Enrico Giustiniano [email protected] 1
Department of Anesthesia and Intensive Care Units, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, Rozzano, 20089 Milan, Italy
2
Echocardiography Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Milan, Italy
3
Department of Biomedical Science, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
lung parenchymal districts, particularly when severe hypoxemia occurred [1]. After a brief period of non-invasive ventilation (NIV), mechanical respiratory support was needed, since patients showe
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