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Observational Study
. 2021 Feb:61:73-75.
doi: 10.1016/j.jcrc.2020.10.002. Epub 2020 Oct 17.

Microcirculation alterations in severe COVID-19 pneumonia

Vanina Siham Kanoore Edul  1 , Juan Francisco Caminos Eguillor  2 , Gonzalo Ferrara  3 , Elisa Estenssoro  2 , Daniel Shiovan Páez Siles  4 , Cristián Emanuel Cesio  3 , Arnaldo Dubin  5
Affiliations
Observational Study

Microcirculation alterations in severe COVID-19 pneumonia

Vanina Siham Kanoore Edul et al. J Crit Care. 2021 Feb.

Abstract

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.

Keywords: COVID-19; Capillary refill time; Microcirculation; Pneumonia.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no competing interests.

References

    1. Bray M.A., Sartain S.A., Gollamudi J., Rumbaut R.E. Microvascular thrombosis: experimental and clinical implications. Transl Res. 2020;225:105–130. - PMC - PubMed
    1. Ackermann M., Verleden S.E., Kuehnel M., Haverich A., Welte T., Laenger F. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med. 2020;383(2):120–128. - PMC - PubMed
    1. Nunes Duarte-Neto A., de Almeida Monteiro R.A., da Silva L.F.F. Pulmonary and systemic involvement of COVID-19 assessed by ultrasound-guided minimally invasive autopsy. Histopathology. 2020;77:186–197. - PMC - PubMed
    1. Schaller T., Hirschbühl K., Burkhardt K., Braun G., Trepel M., Märkl B. Postmortem examination of patients with COVID-19. JAMA. 2020;323(24):2518–2520. - PMC - PubMed
    1. Damiani E., Carsetti A., Casarotta E., Scorcella C., Domizi R., Adrario E. Microvascular alterations in patients with SARS-COV-2 severe pneumonia. Ann Intensive Care. 2020;10(60) - PMC - PubMed

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