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Inventi Impact: Advanced Nursing

Articles

  • Inventi:han/45048/22
    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
    01-Apr-2022 Research 2022 : April-June
    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 on behalf of the HEMOCOVID-19 Consortium

    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 threeminute 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..............

    How to Cite this Article
    Attribution/ CC Compliant Citation: Mesquida, Jaume, et al. "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." Critical Care 25.1 (2021): 1-10. https://doi.org/10.1186/s13054-021-03803-2 http://creativecommons.org/licenses/by/4.0/ Some formatting elements, header, footer, logos, dates and pagination were modified while adapting this article.
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