{
  "abstract": "Background We previously demonstrated a high prevalence of transpulmonary bubble transit (TPBT) using transcranial Doppler (TCD) in patients with COVID-19 pneumonia, but these observations require confirmation.Methods Patients at two academic medical centres, hospitalised with COVID-19 pneumonia and requiring any form of respiratory support, were studied. The first TCD study was performed at the time of enrolment and repeated approximately 7 and 14 days later if participants remained hospitalised.Results 91 participants were enrolled. At the first TCD, 14 participants (15%) were receiving oxygen by nasal cannula, 41 participants (45%) were receiving oxygen by high flow nasal cannula, 8 participants (9%) were receiving non-invasive positive pressure, 28 participants (31%) were receiving mechanical ventilation and 2 participants (2%) were receiving extracorporeal membrane oxygenation. 33 participants (36%) demonstrated TPBT at the first TCD. There was evidence that the presence of TPBT and increased heart rate together was associated with in-hospital death (p=0.02). For every one-unit increase in heart rate, the odds of death increased 11% (OR 1.11, 95% CI 1.02 to 1.20, p=0.01) for those with TPBT; however, there was no evidence of this increase for those without TPBT (OR 1.01, 95% CI 0.97 to 1.05, p=0.76). For participants with subsequent TCD assessments, 55% demonstrated TPBT during the second TCD assessment, and 85% demonstrated TPBT at the third TCD assessment.Conclusions The prevalence of TPBT in hospitalised patients with COVID-19 pneumonia is higher than expected and the presence of TPBT increases over time in those that remained alive and hospitalised. In patients with TPBT, increased heart rate, a marker of hyperdynamic circulation, is associated with increased mortality.",
  "authors": [
    {
      "affiliations": [
        "Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA"
      ],
      "name": "Hooman Poor"
    },
    {
      "affiliations": [
        "Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA"
      ],
      "name": "Adeel Abbasi"
    },
    {
      "affiliations": [
        "Division of Pulmonary and Critical Care Medicine, New York University School of Medicine, New York, New York, USA"
      ],
      "name": "Daniel Howell"
    },
    {
      "affiliations": [
        "Division of Neurocritical Care, Hackensack Meridien School of Medicine, Hackensack, New Jersey, USA"
      ],
      "name": "Alexandra Reynolds"
    },
    {
      "affiliations": [
        "Division of Neurocritical Care, Hackensack Meridien School of Medicine, Hackensack, New Jersey, USA"
      ],
      "name": "Kaitlin Reilly-Kit"
    },
    {
      "affiliations": [
        "Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, USA"
      ],
      "name": "Kevin Rurak"
    },
    {
      "affiliations": [
        "Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA"
      ],
      "name": "Maya Cohen"
    },
    {
      "affiliations": [
        "Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, Rhode Island, USA"
      ],
      "name": "Grayson Baird"
    },
    {
      "affiliations": [
        "Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Lilian Worst"
    },
    {
      "affiliations": [
        "Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Elizabeth Shin"
    },
    {
      "affiliations": [
        "Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Paul Yu"
    },
    {
      "affiliations": [
        "Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA"
      ],
      "name": "Alison Lee"
    },
    {
      "affiliations": [
        "Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA",
        "Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island, USA"
      ],
      "name": "Corey E Ventetuolo"
    }
  ],
  "title": "Transpulmonary bubble transit in patients hospitalised with COVID-19 pneumonia",
  "uid": "7d8b8354-85d7-548f-beb5-56dfc60f1122"
}