Man with dyspnea, dry cough and fever

Abstract

A 60-year-old-man was admitted to the emergency department (ED) with dyspnea, dry cough, and fever. His vital signs showed tachypnea and hypoxemia (SatO2 = 85%). The result of reverse transcription polymerase chain reaction for detection of severe acute respiratory syndrome coronavirus 2RNAwaspositive. Forty-eight hours after admission, the patient required invasive mechanical ventilation with high inspired oxygen fraction levels and positive end-expiratory pressure titration, so prone position ventilation was started. The patient developed hemodynamic instability; the inferior vena cava (IVC) and the hepatic vein flow were evaluated by a transhepatic (TH) view with bedside ultrasonography. Using a phased array sector probe 2–3 mHz, the operator obtained the images on the right side of the patient (Figure 1A). The probe was placed in the 7th–8th intercostal space at the posterior axillary line with the marker pointing to the patient’s head (Figure 1B). The IVC and the hepatic vein (Figure 2) and the respiratory variation of the IVC (Figure 3) were adequately evaluated (Video S1). The Doppler evaluation of hepatic vein flow showed a normal pattern (Figures 4 and 5). A high IVC distensibility index (44%) was reported (alongwith a central venous pressure of 8mmHg); then, a bolus of crystalloid was administrated with improvement in the hemodynamics.