Haemodynamic monitoring and management in COVID-19 intensive care patients: an International survey

Abstract

Purpose To survey haemodynamic monitoring and management practices in intensive care patients with the coronavirus disease 2019 (COVID-19). Methods A questionnaire was shared on social networks or via email by the authors and by Anaesthesia and/or Critical Care societies from France, Switzerland, Belgium, Brazil, and Portugal. Intensivists and anaesthetists involved in COVID-19 ICU care were invited to answer 14 questions about haemodynamic monitoring and management. Results Globally, 1000 questionnaires were available for analysis. Responses came mainly from Europe (n = 460) and America (n = 434). According to a majority of respondents, COVID-19 ICU patients frequently or very frequently received continuous vasopressor support (56%) and had an echocardiography performed (54%). Echocardiography revealed a normal cardiac function, a hyperdynamic state (43%), hypovolaemia (22%), a left ventricular dysfunction (21%) and a right ventricular dilation (20%). Fluid responsiveness was frequently assessed (84%), mainly using echo (62%), and cardiac output was measured in 69%, mostly with echo as well (53%). Venous oxygen saturation was frequently measured (79%), mostly from a CVC blood sample (94%). Tissue perfusion was assessed biologically (93%) and clinically (63%). Pulmonary oedema was detected and quantified mainly using echo (67%) and chest X-ray (61%). Conclusion Our survey confirms that vasopressor support is not uncommon in COVID-19 ICU patients and suggests that different haemodynamic phenotypes may be observed. Ultrasounds were used by many respondents, to assess cardiac function but also to predict fluid responsiveness and quantify pulmonary oedema. Although we observed regional differences, current international guidelines were followed by most respondents.

Could strain echocardiography help to assess systolic function in critically ill COVID-19 patients?

“…Multiple factors may impact cardiac function in critically ill COVID-19 patients, including systemic inflammation, hypoxemia, myocardial ischemia, myocarditis, mechanical ventilation with positive end-expiratory pressure and pulmonary embolism [ 11 – 13 ]. A quick POCUS cardiac evaluation is therefore highly desirable in this context, but a surge of acutely ill patients may limit the feasibility of an operator-dependent and time-consuming procedure [ 14 ]. Recent studies suggest that a decrease in right and left ventricular GLS is an independent predictive factor of tracheal intubation and in-hospital mortality in COVID-19 patients [ 7 , 8 ].…”

Hispanic Patients Hospitalized with COVID-19 Disease-Characteristics and Clinical Outcomes at a Tertiary Care Center in New York City

“…In our study, 34% of patients had hemodynamic instability requiring treatment with vasopressors. One study conducted in Belgium with COVID-19 patients in the ICU setting reported that 56% of patients required vasopressor support [18]. We found that vasopressor use was significantly associated with higher mortality and increased length of stay.…”

Cardio-Pulmonary-Renal Consequences of Severe COVID-19

“…Proactive hemodynamic monitoring starting in the emergency department and non-ICU wards could enable early recognition of hemodynamically deteriorating COVID-19 patients and allow earlier intervention. Noninvasive monitoring tools including ultrasound and echocardiography have been widely used to assess cardiac function and predict fluid responsiveness in these patients [ 41 ]. Moreover, hemodynamic parameters such as blood pressure, cardiac output, pulse pressure variation, pleth variability index, and systemic vascular resistance can noninvasively be measured.…”

“…First in 2002, severe acute respiratory syndrome virus originated in China and caused around 800 deaths worldwide, with an 11% mortality rate [ 2 ]. A decade later in 2012, Middle East respiratory syndrome virus was first reported in Saudi Arabia and affected 2,494 people with a fatality rate of 34% [ 3 ] [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. And again, almost a decade later, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared in late 2019 again in China and was called coronavirus disease 2019 (COVID-19).…”