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7. Peripheral microcirculatory alterations are associated with the severity of acute respiratory distress syndrome in COVID-19 patients admitted to intermediate respiratory and intensive care units

Author

Mesquida, Jaume, Caballer, A., Cortese, L., Vila, C., Karadeniz, U., Pagliazzi, M., Zanoletti, M., Pacheco, A. Pérez, Castro, P., García-de-Acilu, M., Mesquita, R. C., Busch, D. R., Durduran, T., Durduran, Turgut, Pagliazzi, Marco, Cortese, Lorenzo, Zanoletti, Marta, Karadeniz, Umut, Caballer, Alba, Nogales, Sara, Espinal, Cristina, Gruartmoner, Guillem, Terán, Puri Pérez, Vilà, Clara, Picazo, Lucía, Ferrer, Ricard, De Acilu, Marina García, Chiscano, Luis, Mera, Abraham, Castro, Pedro, Téllez, Adrián, Fernández, Sara, Matas, Ana, Fuentes, Fernando, Serra, Isabel, Romero, David, Font, Francesc, Myers, Tim, Busch, David R., Dave, Siddharth, Cheruku, Sreekanth, Choi, Christopher, Lahsaei, Peiman, Olson, DaiWai, Pacheco, Argelia Pérez, Quispe Siccha, Rosa María, Liceaga, Eduardo, De Oca Hernández, Félix Jerandy Monte, Besen, Bruno Adler Maccagnan Pinheiro, Taniguchi, Leandro Utino, Mendes, Pedro Vitale, Mesquita, Rickson Coelho, Soto, Andrés Fabián Quiroga, Aventurato, Italo Karmann, de Oliveira, Laís Bacchin, Delazari, Lilian Elisabete Bernardes, dos Santos, Lígia, Ratti, Roceto, Falcão, Antonio Luis Eiras, Marin-Corral, Judith, Serrano-Loyola, Raúl, Carbajal-Robles, Verónica, Santillan-Aguayo, Enrique, Parada-Guzmán, Melvin, Menezes-Forti, Rodrigo, Bacchin, Luis, Lívio-Emidio, Gabriela, Institut Català de la Salut, [Mesquida J, Caballer A] Àrea de Crítics, Parc Taulí Hospital Universitari, Sabadell, Spain. [Cortese L, Karadeniz U, Pagliazzi M] ICFO Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels, Barcelona, Spain. [Vila C] Servei de Medicina Intensiva, Parc Salut Mar Hospital, Barcelona, Spain. [García-de-Acilu M] Servei de Cures Intensives, Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus

Subjects
Male, Health Care Facilities, Manpower, and Services::Health Facilities::Hospital Units::Intensive Care Units::Respiratory Care Units [HEALTH CARE], ARDS, medicine.medical_treatment, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, medicine.disease_cause, COVID-19 (Malaltia), Circulatory and Respiratory Physiological Phenomena::Cardiovascular Physiological Phenomena::Blood Circulation::Microcirculation [PHENOMENA AND PROCESSES], Severity of Illness Index, instalaciones, servicios y personal de asistencia sanitaria::centros sanitarios::unidades hospitalarias::unidades de cuidados intensivos::unidades de cuidados respiratorios [ATENCIÓN DE SALUD], Hypoxemia, Microcirculació, 0302 clinical medicine, Blood vessels, Fraction of inspired oxygen, virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES], Medicine, Prospective Studies, Endothelial dysfunction, Respiratory system, Unitats de cures intensives, Infrared spectroscopy, Vasos sanguinis, Respiratory Distress Syndrome, Intensive care units, Respiratory Care Units, Respiratory disease, Medical emergencies. Critical care. Intensive care. First aid, Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES], Middle Aged, enfermedades respiratorias::enfermedades pulmonares::síndrome de dificultad respiratoria del adulto [ENFERMEDADES], Intensive Care Units, Cardiology, Trastorns microcirculatoris, Female, medicine.symptom, Nasal cannula, Brazil, Adult, Otros calificadores::/fisiología [Otros calificadores], medicine.medical_specialty, Other subheadings::/physiology [Other subheadings], Respiratory Tract Diseases::Lung Diseases::Respiratory Distress Syndrome, Adult [DISEASES], 03 medical and health sciences, Near-infrared spectroscopy, Internal medicine, Intensive care, Humans, fenómenos fisiológicos respiratorios y circulatorios::fenómenos fisiológicos cardiovasculares::circulación sanguínea::microcirculación [FENÓMENOS Y PROCESOS], Muscle, Skeletal, Mexico, Aged, Mechanical ventilation, RC86-88.9, business.industry, SARS-CoV-2, Research, Microcirculation, Espectroscòpia infraroja, COVID-19, medicine.disease, 030228 respiratory system, Spain, Microvessels, Pulmons - Malalties - Complicacions, business
Abstract

Background COVID-19 is primarily a respiratory disease; however, there is also evidence that it causes endothelial damage in the microvasculature of several organs. The aim of the present study is to characterize in vivo the microvascular reactivity in peripheral skeletal muscle of severe COVID-19 patients. Methods This is a prospective observational study carried out in Spain, Mexico and Brazil. Healthy subjects and severe COVID-19 patients admitted to the intermediate respiratory (IRCU) and intensive care units (ICU) due to hypoxemia were studied. Local tissue/blood oxygen saturation (StO2) and local hemoglobin concentration (THC) were non-invasively measured on the forearm by near-infrared spectroscopy (NIRS). A vascular occlusion test (VOT), a three-minute induced ischemia, was performed in order to obtain dynamic StO2 parameters: deoxygenation rate (DeO2), reoxygenation rate (ReO2), and hyperemic response (HAUC). In COVID-19 patients, the severity of ARDS was evaluated by the ratio between peripheral arterial oxygen saturation (SpO2) and the fraction of inspired oxygen (FiO2) (SF ratio). Results Healthy controls (32) and COVID-19 patients (73) were studied. Baseline StO2 and THC did not differ between the two groups. Dynamic VOT-derived parameters were significantly impaired in COVID-19 patients showing lower metabolic rate (DeO2) and diminished endothelial reactivity. At enrollment, most COVID-19 patients were receiving invasive mechanical ventilation (MV) (53%) or high-flow nasal cannula support (32%). Patients on MV were also receiving sedative agents (100%) and vasopressors (29%). Baseline StO2 and DeO2 negatively correlated with SF ratio, while ReO2 showed a positive correlation with SF ratio. There were significant differences in baseline StO2 and ReO2 among the different ARDS groups according to SF ratio, but not among different respiratory support therapies. Conclusion Patients with severe COVID-19 show systemic microcirculatory alterations suggestive of endothelial dysfunction, and these alterations are associated with the severity of ARDS. Further evaluation is needed to determine whether these observations have prognostic implications. These results represent interim findings of the ongoing HEMOCOVID-19 trial. Trial registration ClinicalTrials.gov NCT04689477. Retrospectively registered 30 December 2020.

Published
2021

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