TY - JOUR
T1 - 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
AU - the HEMOCOVID-19 Consortium
AU - Mesquida, Jaume
AU - Caballer, A.
AU - Cortese, L.
AU - Vila, C.
AU - Karadeniz, U.
AU - Pagliazzi, M.
AU - Zanoletti, M.
AU - Pacheco, A. Pérez
AU - Castro, P.
AU - García-de-Acilu, M.
AU - Mesquita, R. C.
AU - Busch, D. R.
AU - Durduran, T.
AU - Durduran, Turgut
AU - Pagliazzi, Marco
AU - Cortese, Lorenzo
AU - Zanoletti, Marta
AU - Karadeniz, Umut
AU - Mesquida, Jaume
AU - Caballer, Alba
AU - Nogales, Sara
AU - Espinal, Cristina
AU - Gruartmoner, Guillem
AU - Terán, Puri Pérez
AU - Vilà, Clara
AU - Picazo, Lucía
AU - Ferrer, Ricard
AU - De Acilu, Marina García
AU - Chiscano, Luis
AU - Mera, Abraham
AU - Castro, Pedro
AU - Téllez, Adrián
AU - Fernández, Sara
AU - Matas, Ana
AU - Fuentes, Fernando
AU - Serra, Isabel
AU - Romero, David
AU - Font, Francesc
AU - Myers, Tim
AU - Busch, David R.
AU - Dave, Siddharth
AU - Cheruku, Sreekanth
AU - Choi, Christopher
AU - Lahsaei, Peiman
AU - Olson, Dai Wai
AU - Pacheco, Argelia Pérez
AU - Quispe Siccha, Rosa María
AU - Liceaga, Eduardo
AU - De Oca Hernández, Félix Jerandy Monte
AU - Besen, Bruno Adler Maccagnan Pinheiro
N1 - Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - 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.
AB - 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.
KW - COVID-19
KW - Endothelial dysfunction
KW - Microcirculation
KW - Near-infrared spectroscopy
UR - http://www.scopus.com/inward/record.url?scp=85118840727&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85118840727&partnerID=8YFLogxK
U2 - 10.1186/s13054-021-03803-2
DO - 10.1186/s13054-021-03803-2
M3 - Article
C2 - 34749792
AN - SCOPUS:85118840727
SN - 1364-8535
VL - 25
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 381
ER -