Microcirculation alterations in severe COVID-19 pneumonia
Vanina Siham Kanoore Edul1, Juan Francisco Caminos Eguillor2, Gonzalo Ferrara3
1Hospital Juan A Fernández, Ciudad Autónoma de Buenos Aires, Argentina; Cátedra de Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina; Sanatorio Otamendi, Buenos Aires, Argentina.
Purpose:
To assess the presence of sublingual microcirculatory and skin perfusion alterations in COVID-19 pneumonia.
Materials And Methods:
This is a preliminary report of a prospective observational study performed in four teaching intensive care units. We studied 27 mechanically ventilated patients with acute respiratory distress syndrome secondary to COVID-19. Sublingual microcirculation was assessed by hand-held videomicroscopy. A software-assisted analysis of videos was performed. We also measured capillary refill time.
Results:
Patients were hemodynamically stable with normal lactate (1.8 [1.6-2.5] mmol/L) and high D-dimer (1.30 [0.58-2.93] μg/mL). Capillary refill time was prolonged (3.5 [3.0-5.0] s). Compared to previously reported normal values, total and perfused vascular density (21.9 ± 3.9 and 21.0 ± 3.5 mm/mm2) and heterogeneity flow index (0.91 ± 0.24) were high; and the proportion of perfused vessels (0.96 ± 0.03), microvascular flow index (2.79 ± 0.10), and red blood cell velocity (1124 ± 161 μm/s) were reduced. The proportion of perfused vessels was inversely correlated with total vascular density (Pearson r = -0.41, P = 0.03).
Conclusions:
COVID-19 patients showed an altered tissue perfusion. Sublingual microcirculation was characterized by decreases in the proportion of perfused vessel and flow velocity along with high vascular densities. This last finding might be related to enhanced angiogenesis or hypoxia-induced capillary recruitment.
Insights
COVID-19 pneumonia alters tissue perfusion, with reduced sublingual microvascular flow and velocity. Patients exhibited high vascular densities, potentially due to angiogenesis or hypoxia, indicating significant microcirculatory changes.
Area of Science:
- Critical Care Medicine
- Microcirculation Research
- COVID-19 Pathophysiology
Background:
- COVID-19 pneumonia can lead to systemic complications, including microcirculatory dysfunction.
- Assessing tissue perfusion is crucial for managing critically ill patients with COVID-19.
Purpose of the Study:
- To investigate sublingual microcirculatory and skin perfusion alterations in mechanically ventilated COVID-19 pneumonia patients.
- To characterize microvascular changes associated with COVID-19 acute respiratory distress syndrome.
Main Methods:
- Prospective observational study of 27 mechanically ventilated COVID-19 patients.
- Sublingual microcirculation assessed using hand-held videomicroscopy with software analysis.
- Capillary refill time measured to evaluate peripheral perfusion.
Main Results:
- Patients presented with prolonged capillary refill time (3.5s).
- Sublingual microcirculation showed reduced proportion of perfused vessels (0.96) and lower red blood cell velocity (1124 μm/s).
- High total and perfused vascular densities (21.9 mm/mm² and 21.0 mm/mm²) were observed, with an inverse correlation between perfused vessels and total vascular density.
Conclusions:
- COVID-19 pneumonia is associated with significant alterations in tissue perfusion and sublingual microcirculation.
- Observed microcirculatory changes include decreased vessel perfusion and flow velocity, alongside increased vascular density.
- Elevated vascular density may indicate compensatory angiogenesis or hypoxia-driven capillary recruitment in response to COVID-19.
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