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Evaluation of microcirculation disorders in patients with severe COVID-19 by nail bed capillaroscopy
- Source :
- Вестник анестезиологии и реаниматологии, Vol 18, Iss 1, Pp 27-36 (2021)
- Publication Year :
- 2021
- Publisher :
- NEW TERRA Publishing House, 2021.
-
Abstract
- Microcirculation disorders caused by thrombosis are the most important factor determining the pathogenesis of organ damage in severe COVID-19 including the absence of obvious macrohemodynamic instability. However, there are very few publications demonstrating the results of intravital visualization of changes in the microcirculation system in this disease.The objective: to assess the state of microcirculation in patients with viral pneumonia associated with COVID-19 using nail bed microscopy.Subjects and methods. Eleven patients with COVID-19 were examined; they were admitted to the intensive care unit due to progressing acute respiratory failure. Vital microscopy of the microcirculatory bloodstream in the fingers’ nail bed was performed by admission and over time. When assessing microcirculation, the presence of aggregates in the lumen of capillaries and avascular zones, and the linear velocity of blood flow were taken into account. The results were summarized taking with the outcome consideration (6 people recovered, 5 died). Results. Microcirculation disorders were objectively confirmed in all patients. In 100% of cases, microaggregates were detected in the capillary lumen. The values of the mean linear velocity of capillary blood flow turned out to be extremely variable. However, the values of the maximum linear velocities of capillary blood flow in the patients who subsequently died were significantly lower versus survivors (190 μm/sec (135.5; 237) and 387 μm/sec (329.3; 407.5), p = 0.018). The irregularity of blood flow in the visualized field was revealed: when the value of the maximum linear velocity in some capillaries was less than 180 µm/sec, in others, disturbances in the form of pendulum-like movement were already noted. Further slowing down of the blood flow velocity led to the development of stasis and the formation of avascular zones.Conclusion. Impaired microcirculation (decreased blood flow rate in the capillaries, the presence of microaggregates and a lower number of perfused capillaries in the form of avascular zones) develops in all patients with severe COVID-19.
- Subjects :
- medicine.medical_specialty
ARDS
Lumen (anatomy)
microcirculation
capillaroscopy
Critical Care and Intensive Care Medicine
law.invention
Microcirculation
Pathogenesis
03 medical and health sciences
0302 clinical medicine
law
Internal medicine
0502 economics and business
Medicine
030212 general & internal medicine
business.industry
RC86-88.9
05 social sciences
Medical emergencies. Critical care. Intensive care. First aid
Blood flow
medicine.disease
Thrombosis
Intensive care unit
Anesthesiology and Pain Medicine
medicine.anatomical_structure
covid-19
ards
Emergency Medicine
Cardiology
Nail (anatomy)
050211 marketing
business
Subjects
Details
- Language :
- Russian
- ISSN :
- 25418653 and 20785658
- Volume :
- 18
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Вестник анестезиологии и реаниматологии
- Accession number :
- edsair.doi.dedup.....2ea885b81b0e004e81e4626ef3ebe8c3