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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
- Source :
- Critical Care, Scientia, Critical Care, Vol 25, Iss 1, Pp 1-10 (2021), Dipòsit Digital de la UB, Universidad de Barcelona
- Publication Year :
- 2021
- Publisher :
- BioMed Central, 2021.
-
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.
- 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
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Critical Care, Scientia, Critical Care, Vol 25, Iss 1, Pp 1-10 (2021), Dipòsit Digital de la UB, Universidad de Barcelona
- Accession number :
- edsair.doi.dedup.....c5b7d11ba223496d0a1a306a0605a141