Critical care ultrasonography during COVID-19 pandemic: The ORACLE protocol.

García-Cruz, Edgar; Manzur-Sandoval, Daniel; Rascón-Sabido, Rafael; Gopar-Nieto, Rodrigo; Barajas-Campos, Ricardo Leopoldo; Jordán-Ríos, Antonio; Sierra-Lara Martínez, Daniel; Jiménez-Rodríguez, Gian Manuel; Murillo-Ochoa, Adriana Lizeth; Díaz-Méndez, Arturo; Lazcano-Díaz, Emmanuel; Araiza-Garaygordobil, Diego; Cabello-López, Alejandro; Melano-Carranza, Efrén; Bucio-Reta, Eduardo; González-Ruiz, Francisco Javier; Cota-Apodaca, Luis Antonio; Santos-Martínez, Luis Efrén; Fernández-de la Reguera, Guillermo; Ramos-Enríquez, Ángel; Rojas-Velasco, Gustavo; Álvarez-Álvarez, Rolando Joel; Baranda-Tovar, Francisco

BACKGROUND Coronavirus disease 2019 (COVID-19) is characterized by severe lung involvement and hemodynamic alterations. Critical care ultrasonography is vital because it provides real time information for diagnosis and treatment. Suggested protocols for image acquisition and measurements have not yet been evaluated. METHODS This cross-sectional study was conducted at two centers from 1 April 2020 to 30 May 2020 in adult patients with confirmed COVID-19 infection admitted to the critical care unit. Cardiac and pulmonary evaluations were performed using the ORACLE protocol, specifically designed for this study, to ensure a structured process of image acquisition and limit staff exposure to the infection. RESULTS Eighty-two consecutively admitted patients were evaluated. Most of the patients were males, with a median age of 56 years, and the most frequent comorbidities were hypertension and type 2 diabetes, and 25% of the patients had severe acute respiratory distress syndrome. The most frequent ultrasonographic findings were elevated pulmonary artery systolic pressure (69.5%), E/e' ratio > 14 (29.3%), and right ventricular dilatation (28%) and dysfunction (26.8%). A high rate of fluid responsiveness (82.9%) was observed. The median score (19 points) on pulmonary ultrasound did not reveal any variation between the groups. Elevated pulmonary artery systolic pressure was associated with higher in-hospital mortality. CONCLUSION The ORACLE protocol was a feasible, rapid, and safe bedside tool for hemodynamic and respiratory evaluation of patients with COVID-19. Further studies should be performed on the alteration in pulmonary hemodynamics and right ventricular function and its relationship with outcomes.