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

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 C...

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Autores principales:	Jaume Mesquida, A. Caballer, L. Cortese, C. Vila, U. Karadeniz, M. Pagliazzi, M. Zanoletti, A. Pérez Pacheco, P. Castro, M. García-de-Acilu, R. C. Mesquita, D. R. Busch, T. Durduran, the HEMOCOVID-19 Consortium
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	COVID-19 Microcirculation Near-infrared spectroscopy Endothelial dysfunction Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/ce56be7464e846e7aa2214ff32751b0a
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spelling	oai:doaj.org-article:ce56be7464e846e7aa2214ff32751b0a2021-11-14T12:05:55ZPeripheral microcirculatory alterations are associated with the severity of acute respiratory distress syndrome in COVID-19 patients admitted to intermediate respiratory and intensive care units10.1186/s13054-021-03803-21364-8535https://doaj.org/article/ce56be7464e846e7aa2214ff32751b0a2021-11-01T00:00:00Zhttps://doi.org/10.1186/s13054-021-03803-2https://doaj.org/toc/1364-8535Abstract 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.Jaume MesquidaA. CaballerL. CorteseC. VilaU. KaradenizM. PagliazziM. ZanolettiA. Pérez PachecoP. CastroM. García-de-AciluR. C. MesquitaD. R. BuschT. Durduranthe HEMOCOVID-19 ConsortiumBMCarticleCOVID-19MicrocirculationNear-infrared spectroscopyEndothelial dysfunctionMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care, Vol 25, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	COVID-19 Microcirculation Near-infrared spectroscopy Endothelial dysfunction Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	COVID-19 Microcirculation Near-infrared spectroscopy Endothelial dysfunction Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Jaume Mesquida A. Caballer L. Cortese C. Vila U. Karadeniz M. Pagliazzi M. Zanoletti A. Pérez Pacheco P. Castro M. García-de-Acilu R. C. Mesquita D. R. Busch T. Durduran the HEMOCOVID-19 Consortium 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
description	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.
format	article
author	Jaume Mesquida A. Caballer L. Cortese C. Vila U. Karadeniz M. Pagliazzi M. Zanoletti A. Pérez Pacheco P. Castro M. García-de-Acilu R. C. Mesquita D. R. Busch T. Durduran the HEMOCOVID-19 Consortium
author_facet	Jaume Mesquida A. Caballer L. Cortese C. Vila U. Karadeniz M. Pagliazzi M. Zanoletti A. Pérez Pacheco P. Castro M. García-de-Acilu R. C. Mesquita D. R. Busch T. Durduran the HEMOCOVID-19 Consortium
author_sort	Jaume Mesquida
title	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
title_short	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
title_full	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
title_fullStr	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
title_full_unstemmed	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
title_sort	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
publisher	BMC
publishDate	2021
url	https://doaj.org/article/ce56be7464e846e7aa2214ff32751b0a
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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

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