Intrapulmonary and Intracardiac Shunts in Adult COVID-19 Versus Non-COVID Acute Respiratory Distress Syndrome ICU Patients Using Echocardiography and Contrast Bubble Studies (COVID-Shunt Study): A Prospective, Observational Cohort Study

Lau, VI; Mah, GD; Wang, X; Byker, L; Robinson, A; Milovanovic, L; Alherbish, A; Odenbach, J; Vadeanu, C; Lu, D; Smyth, L; Rohatensky, M; Whiteside, B; Gregoire, P; Luksun, W; van Diepen, S; Anderson, D; Verma, S; Slemko, J; Brindley, P; Kustogiannis, DJ; Jacka, M; Shaw, A; Wheatley, M; Windram, J; Opgenorth, D; Baig, N; Rewa, OG; Bagshaw, SM; Buchanan, BM

doi:10.1097/ccm.0000000000005848

Respiratory failure & ventilation

Intrapulmonary and Intracardiac Shunts in Adult COVID-19 Versus Non-COVID Acute Respiratory Distress Syndrome ICU Patients Using Echocardiography and Contrast Bubble Studies (COVID-Shunt Study): A Prospective, Observational Cohort Study

Crit Care MedPublished 27 Mar 2023Prospective observational cohort study

Main finding · R-L shunt frequencyResultRD −5.7% 95% CI −18.4 to 7.0

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Authors' conclusion

There was no evidence of increased R-L shunt rates in COVID-19 compared with non-COVID controls. R-L shunt was associated with increased in-hospital mortality for COVID-19 patients, but this did not persist at 90-day mortality or after adjusting using logistic regression.

Study context

Population: Adult critically ill, mechanically ventilated ICU patients with COVID-19 or non-COVID acute respiratory distress syndrome (ARDS), 4 tertiary hospitals, Edmonton, Canada, Nov 2020–Sep 2021
Participants: 226 participants

Exposure: COVID-19 vs non-COVID ARDS
COVID-19n = 182
non-COVIDn = 44reference
Outcome: R-L shunt frequency (agitated-saline bubble studies) and association with hospital mortality

Methodological detailsmulticentre

Multicentre

Main finding

R-L shunt frequency

RD

−5.7%

95% CI −18.4 to 7.0

P = 0.38

Events by group

COVID-1917.0%31 of 182

non-COVID22.7%10 of 44

COVID-19 vs non-COVID

RD −5.7% (95% CI −18.4 to 7.0); P = 0.38

As reported in the abstract

Observational data: associations, not effects.

Further findings

Outcome	R-L shunt	No shunt	← Lower with R-L shunt ←→ Higher with R-L shunt →	RD (95% CI)	P value
Hospital mortality, R-L shunt vs no shunt (COVID-19 subgroup)	54.8%	35.8%	−2002040	19.0% (0.1–37.9)	P = 0.05
			−2002040Difference (linear scale)

Hospital mortality, right-to-left (R-L) shunt vs no shunt (COVID-19 subgroup)

Association did not persist at 90-day mortality nor after logistic regression adjustment

Original publication

Intrapulmonary and Intracardiac Shunts in Adult COVID-19 Versus Non-COVID Acute Respiratory Distress Syndrome ICU Patients Using Echocardiography and Contrast Bubble Studies (COVID-Shunt Study): A Prospective, Observational Cohort Study. Crit Care Med. Published 27 March 2023. doi:10.1097/ccm.0000000000005848

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