Detection of Pulmonary Shunts by Transcranial Doppler in Hospitalized Non-mechanically Ventilated Coronavirus Disease-19 Patients

Salazar-Orellana, Jaime Leonardo I; García‐Grimshaw, Miguel; Valdés‐Ferrer, Sergio Iván; Alday-Ramírez, Sergio M; Argaiz, Eduardo R.; Vásquez-Ortiz, Zuilma Y.; Rivero-Sigarroa, Eduardo; Jiménez‐Ruiz, Amado; Chiquete, Erwin; Cantú-Brito, Carlos; Flores-Silva, Fernando

doi:10.24875/ric.20000569

Cited by 6 publications

(13 citation statements)

References 4 publications

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“…Where ARDS mortality data was reported (n = 5 studies, 845 patients), the meta-analysis of pooled studies yielded 42.3% mortality (69/163 patients, 95% CI: 34.6-50.3%) for shunt presence compared to 32.0% mortality (218/682 patients, 95% CI: 28.5-35.6%) for shunt absence (risk difference: 10.3% [95% CI: 0.2-18.7%], relative risk [RR]: 1.22, [95% CI: 1.01-1.49], p=0.04, very low certainty). Forest plot for pooled mortality is shown in Figure 2 (2, 24–27).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 1,114 patients were pooled between 10 studies with an overall shunt prevalence of 21.8% as detected by various agitated saline bubble sonography modalities with individual studies ranging from 14.4-30.0% (2, 6, 7, 24-29) (2,(5)(6)(7)(21)(22)(23)(24)(25)(26). The majority of studies included ARDS secondary to infectious pneumonia, with 3 COVID-19 specific studies (6,7,24). Where reported, included studies demonstrated a male predominance (72.3%) and a mean age of 58.5 years.…”

Section: Clinical Outcomesmentioning

confidence: 99%

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Acute respiratory distress syndrome and shunt detection with bubble studies: a systematic review and meta-analysis

Odenbach

Dhanoa

Sebastianski

et al. 2022

Preprint

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Objectives: Acute respiratory distress syndrome (ARDS) is a life-threatening respiratory injury with multiple physiological sequalae. Shunting of deoxygenated blood through intra and extra-pulmonary shunts is one consequence that may complicate ARDS management. Therefore, we conducted a systematic review to determine the prevalence of sonographically detected shunt and its association with oxygenation and mortality in patients with ARDS. Data Sources: We searched MEDLINE, EMBASE, Cochrane Library and DARE databases on March 26, 2021 Study Selection: Articles relating to respiratory failure and sonographic shunt detection. Data Extraction: Articles were independently screened and extracted in duplicate. Data pertaining to study demographics and shunt detection were compiled for mortality and oxygenation outcomes. Risk of bias was appraised using the Joanna Briggs Institute and Newcastle-Ottawa Scale tools with evidence rating certainty using GRADE methodology. Data Synthesis: From 4,617 citations, 10 observational studies met eligibility criteria. Sonographic detection of right-to-left shunt was present in 21.8% of patients (range: 14.4-30.0%) amongst included studies using transthoracic, transesophageal and transcranial bubble Doppler sonography. Shunt prevalence may be associated with increased mortality (risk ratio: 1.22, 95% CI: 1.01-1.49, p=0.04, very low certainty evidence) with no difference in oxygenation as measured by PaO2:FiO2 ratio (mean difference -0.7, 95% CI: -18.6 to 17.2, p=0.94, very low certainty evidence). Conclusions: Intra- and extra-pulmonary shunts are detected frequently in ARDS with ultrasound techniques. Shunts may increase mortality amongst patients with ARDS, but its association with oxygenation is uncertain. Future research should explore the role of shunt in ARDS, their association with mortality, and whether targeted precision medicine interventions can improve outcomes. PROSPERO Registration Number: CRD42021245194 (March 26, 2021)

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Section: Resultsmentioning

confidence: 99%

Section: Clinical Outcomesmentioning

confidence: 99%

Acute respiratory distress syndrome and shunt detection with bubble studies: a systematic review and meta-analysis

Odenbach

Dhanoa

Sebastianski

et al. 2022

Preprint

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“…The disease spread worldwide rapidly, and on March 11, 2020, it was declared a pandemic by the World Health Organization ( World Health Organization, 2020 ). SARS-CoV-2-associated disease (COVID-19) can lead to massive respiratory tract damage and fatal lung failure, mainly secondary to pulmonary vascular pathology ( Ackermann et al, 2020 ; Hariri et al, 2021 ; Salazar-Orellana et al, 2021 ). Still, the reported symptoms have substantial variations among series.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and predictors for silent hypoxemia in a cohort of hospitalized COVID-19 patients

García‐Grimshaw¹,

Flores-Silva²,

Chiquete³

et al. 2021

Autonomic Neuroscience

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Background An intriguing feature recently unveiled in some COVID-19 patients is the “silent hypoxemia” phenomenon, which refers to the discrepancy of subjective well-being sensation while suffering hypoxia, manifested as the absence of dyspnea. Objective To describe the clinical characteristics and predictors of silent hypoxemia in hospitalized COVID-19 patients. Methods We conducted a prospective cohort study including consecutive hospitalized adult (≥ 18 years) patients with confirmed COVID-19 presenting to the emergency department with oxygen saturation (SpO2) ≤ 80% on room air from March 15 to June 30, 2020. We analyzed the characteristics, disease severity, and in-hospital outcomes of patients presenting with dyspnea and those without dyspnea (silent hypoxemia). Results We studied 470 cases (64.4% men; median age 55 years, interquartile range 46–64). There were 447 (95.1%) patients with dyspnea and 23 (4.9%) with silent hypoxemia. The demographic and clinical characteristics, comorbidities, laboratory and imaging findings, disease severity, and outcomes were similar between groups. Higher breathing and heart rates correlated significantly with lower SpO 2 in patients with dyspnea but not in those with silent hypoxemia. Independent predictors of silent hypoxemia were the presence of new-onset headache (OR 2.919, 95% CI 1.101–7.742; P = 0.031) and presenting to the emergency department within the first eight days after symptoms onset (OR 3.183, 95% CI 1.024–9.89; P = 0.045). Conclusions Patients with silent hypoxemia sought medical attention earlier and had new-onset headache more often. They were also likely to display lower hemodynamic compensatory responses to hypoxemia, which may underestimate the disease severity.

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“…Endothelial damage-related respiratory failure is the leading cause of death in COVID-19 [95 ▪▪ ,96 ▪▪ ,97,98]. Severe hypoxemia is associated with cerebral atrophy, especially of oxygen susceptible cognition-related structures [99,100].…”

Section: Neurocognitive Dysfunctionmentioning

confidence: 99%

Neurocognitive and psychiatric post-coronavirus disease 2019 conditions: pathogenic insights of brain dysfunction following severe acute respiratory syndrome coronavirus 2 infection

García‐Grimshaw

Sankowski

Valdés‐Ferrer

2022

Current Opinion in Neurology

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Purpose of reviewSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiological agent of coronavirus disease 2019 , can trigger a myriad of neuropsychiatric manifestations. As a 2-year-old disease (at the writing of this manuscript), its long-term cognitive and neuropsychiatric implications, known as post-COVID-19 conditions, are incompletely recognized and mechanistically obscure. Recent findingsFatigue, anxiety, depression, posttraumatic stress disorder, and cognitive dysfunction are reported more frequently in COVID-19 survivors than in matching, non-COVID-19 population. Risk factors are unclear, including comorbidities, age at COVID-19 onset, or disease severity; women, however, have been reported to be at increased risk than men. Although the frequency of these symptoms decreases over time, at least one in five will have persistent cognitive and neuropsychiatric manifestations one year after recovering from COVID-19. SummaryNeurocognitive and psychiatric post-COVID-19 long-term conditions are frequent and complex multifactorial sequelae. Several acute and chronic factors such as hypoxemia, cerebral thrombotic and inflammatory endothelial damage, and disruption of the blood-brain barrier (leading to parenchymal translocation of pro-inflammatory molecules, cytokines, and cytotoxic T lymphocytes) are involved, leading to microglial activation and astrogliosis. As an evolving topic, evidence derived from prospective studies will expand our understanding of post-COVID-19 these long-term outcomes.

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Detection of Pulmonary Shunts by Transcranial Doppler in Hospitalized Non-mechanically Ventilated Coronavirus Disease-19 Patients

Cited by 6 publications

References 4 publications

Acute respiratory distress syndrome and shunt detection with bubble studies: a systematic review and meta-analysis

Acute respiratory distress syndrome and shunt detection with bubble studies: a systematic review and meta-analysis

Characteristics and predictors for silent hypoxemia in a cohort of hospitalized COVID-19 patients

Neurocognitive and psychiatric post-coronavirus disease 2019 conditions: pathogenic insights of brain dysfunction following severe acute respiratory syndrome coronavirus 2 infection

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