Description of the position and performance of an echocardiogram by subcostal view during the prone position in a patient with severe pneumonia caused by COVID-19

• Published in: BMJ case reports Vol. 13; no. 11; p. e239230
• Main Authors: Del Castillo Gordillo, Cesar, Yañez Vidal, Francisca, Begazo Gonzales, Arnulfo, Alfaro Diaz, Mario
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 09.11.2020; BMJ Publishing Group
• Subjects: Cardiovascular Diseases - etiology; Case reports; Coronavirus Infections - complications; Coronaviruses; COVID-19; Critical care; Echocardiography - methods; Feasibility studies; Hemodynamics; Humans; Images In; Intensive care; Male; Middle Aged; Pandemics; Patient Positioning - methods; Patients; Pneumonia; Pneumonia - etiology; Pneumonia, Viral - complications; Prone Position; Pulmonary arteries; Ultrasonic imaging; Ventilators; pneumonia (infectious disease); mechanical ventilation; ultrasonography; adult intensive care
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-239230

Echocardiography is a fundamental tool for the diagnosis and haemodynamic monitoring of critically ill and cardiovascular patients.1 Transthoracic echocardiography (TTE) has the advantages of being non-invasive and safe, and it has noted availability in critical care environments.1 TTE recently emerged as an alternative to monitor patients in the prone position, with adequate imaging at possibly greater proximity of the heart to the chest wall in this position than in the supine position.2 3 A more favourable angle to evaluate the measurements of the inferior vena cava was also described, it tended to increase in size when passing from supine to prone and its compliance may contribute to the evaluation of the volume status in the prone position.4–6 Previous researches described that apical views allowed the evaluation of ventricular and valve function.3 6 7 A described position, where the patient’s left arm was raised and a pillow placed underneath the midthoracic wall to maintain the left hemithorax in a slightly elevated position, allowed only the apical view to be obtained.7 In another position, named the ‘swimmer position’, the patient’s left arm was extended overhead at the shoulder with the elbow bent, and a pillow was placed under the left shoulder to slightly elevate the lateral chest from the bed. Evaluation of the pulmonary valve was performed, which allows the determination of the presence of pulmonary hypertension by measuring the RVOT acceleration time that was not described in previous publications.8 The prone position with a pillow under the hemithorax is easily obtainable in most mobilisation protocols for these patients, without increasing the risk of them. [...]this publication describes the novel use of TTE in the prone position, providing the possibility to perform cardiovascular assessments in the subcostal view.