학술논문
Intrapulmonary and Intracardiac Shunts in Adult COVID-19 Versus Non-COVID Acute Respiratory Distress Syndrome ICU Patients Using Echocardiography and Contrast Bubble Studies (COVID-Shunt Study): A Prospective, Observational Cohort Study
Document Type
Academic Journal
Author
Lau, Vincent I.; Mah, Graham D.; Wang, Xiaoming; Byker, Leon; Robinson, Andrea; Milovanovic, Lazar; Alherbish, Aws; Odenbach, Jeffrey; Vadeanu, Cristian; Lu, David; Smyth, Leo; Rohatensky, Mitchell; Whiteside, Brian; Gregoire, Phillip; Luksun, Warren; van Diepen, Sean; Anderson, Dustin; Verma, Sanam; Slemko, Jocelyn; Brindley, Peter; Kustogiannis, Demetrios J.; Jacka, Michael; Shaw, Andrew; Wheatley, Matt; Windram, Jonathan; Opgenorth, Dawn; Baig, Nadia; Rewa, Oleksa G.; Bagshaw, Sean M.; Buchanan, Brian M.
Source
Critical Care Medicine. Aug 01, 2023 51(8):1023-1032
Subject
Language
English
ISSN
0090-3493
Abstract
OBJECTIVES:: Studies have suggested intrapulmonary shunts may contribute to hypoxemia in COVID-19 acute respiratory distress syndrome (ARDS) with worse associated outcomes. We evaluated the presence of right-to-left (R-L) shunts in COVID-19 and non-COVID ARDS patients using a comprehensive hypoxemia workup for shunt etiology and associations with mortality. DESIGN:: Prospective, observational cohort study. SETTING:: Four tertiary hospitals in Edmonton, Alberta, Canada. PATIENTS:: Adult critically ill, mechanically ventilated, ICU patients admitted with COVID-19 or non-COVID (November 16, 2020, to September 1, 2021). INTERVENTIONS:: Agitated-saline bubble studies with transthoracic echocardiography/transcranial Doppler ± transesophageal echocardiography assessed for R-L shunts presence. MEASUREMENTS AND MAIN RESULTS:: Primary outcomes were shunt frequency and association with hospital mortality. Logistic regression analysis was used for adjustment. The study enrolled 226 patients (182 COVID-19 vs 42 non-COVID). Median age was 58 years (interquartile range [IQR], 47–67 yr) and Acute Physiology and Chronic Health Evaluation II scores of 30 (IQR, 21–36). In COVID-19 patients, the frequency of R-L shunt was 31 of 182 COVID patients (17.0%) versus 10 of 44 non-COVID patients (22.7%), with no difference detected in shunt rates (risk difference [RD], –5.7%; 95% CI, –18.4 to 7.0; p = 0.38). In the COVID-19 group, hospital mortality was higher for those with R-L shunt compared with those without (54.8% vs 35.8%; RD, 19.0%; 95% CI, 0.1–37.9; p = 0.05). This did not persist at 90-day mortality nor after adjustment with regression. CONCLUSIONS:: There was no evidence of increased R-L shunt rates in COVID-19 compared with non-COVID controls. R-L shunt was associated with increased in-hospital mortality for COVID-19 patients, but this did not persist at 90-day mortality or after adjusting using logistic regression.