Cardiopulmonary Ultrasonography for Severe Coronavirus Disease 2019 Patients in Prone Position

Abstract

A 50-year old female presented to the emergency department with a 6-day history of fever, progressively worsening cough and shortness of breath. The patient did not report any contact with anyone who had been recently unwell or had been travelling. Upon arrival to the emergency room, the patient was noted to be severely hypoxaemic by pulse oximetry (66%) and in impeding respiratory failure, so she was emergently intubated for mechanical ventilatory support. Immediately post-intubation, arterial blood gas was as follows: pH 7.34, pCO2 31 mmHg, pO2 60 mmHg, O2 saturation 90%, calculated HCO3 16 mmol/l on FiO2 of 100% and PaO2/FIO2 ratio of 60. Her ventilatory mode was set at controlled minute ventilation, with a respiratory rate of 24, tidal volume of 300 cc (6 cc/ ideal body weight), positive end-expiratory pressure (PEEP) of 20 cmH2O and FiO2 of 100%. The patient’s chest X-ray at the time of admission showed diffuse bilateral pulmonary opacities consistent with multifocal pneumonia or pulmonary oedema (Figure 1). Polymerase chain reaction (PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was sent and came back positive after 48 hours.