Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb 8;16(2):e0246636.
doi: 10.1371/journal.pone.0246636. eCollection 2021.

Microvascular flow alterations in critically ill COVID-19 patients: A prospective study

Osama Abou-Arab  1 , Christophe Beyls  1 , Abdelilah Khalipha  1 , Mathieu Guilbart  1 , Pierre Huette  1 , Stéphanie Malaquin  1 , Benoit Lecat  1 , Pierre-Yves Macq  1 , Pierre Alexandre Roger  1 , Guillaume Haye  1 , Michaël Bernasinski  1 , Patricia Besserve  1 , Sandrine Soriot-Thomas  2 , Vincent Jounieaux  3 , Hervé Dupont  1 , Yazine Mahjoub  1
Affiliations

Microvascular flow alterations in critically ill COVID-19 patients: A prospective study

Osama Abou-Arab et al. PLoS One. .

Abstract

Background: Data on microcirculatory pattern of COVID-19 critically ill patients are scarce. The objective was to compare sublingual microcirculation parameters of critically ill patients according to the severity of the disease.

Methods: The study is a single-center prospective study with critically ill COVID-19 patients admitted in ICU. Sublingual microcirculation was assessed by IDF microscopy within 48 hours of ICU admission. Microcirculatory flow index (MFI), proportion of perfused vessel (PPV), total vessel density (TVD), De Backer score (DBS), perfused vessel density (PVD) and heterogeneity index (HI) were assessed. Patients were divided in 2 groups (severe and critical) according to the World health organization definition.

Findings: From 19th of March to 7th of April 2020, 43 patients were included. Fourteen patients (33%) were in the severe group and twenty-nine patients (67%) in the critical group. Patients in the critical group were all mechanically ventilated. The critical group had significantly higher values of MFI, DBS and PVD in comparison to severe group (respectively, PaCO2: 49 [44-45] vs 36 [33-37] mmHg; p<0,0001, MFI: 2.8 ± 0.2 vs 2.5 ± 0.3; p = 0.001, DBS: 12.7 ± 2.6 vs 10.8 ± 2.0 vessels mm-2; p = 0.033, PVD: 12.5 ± 3.0 vs 10.1 ± 2.4 mm.mm-2; p = 0.020). PPV, HI and TVD were similar between groups Correlation was found between microcirculatory parameters and PaCO2 levels.

Conclusion: Critical COVID-19 patients under mechanical ventilation seem to have higher red blood cell velocity than severe non-ventilated patients.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Comparisons of microcirculatory flow index (MFI), total vessel density (TVD), perfused vessel density (PVD), proportion of perfused vessel (PPV), De Backer score (DBS) and heterogeneity index (HI) in severe group and critical group.
*: P value <0.05 between groups comparisons using Mann-Whitney U test.
Fig 2
Fig 2. PaCO2 correlation with the microcirculatory flow index (MFI), the perfused vessel density (PVD) and the De Backer score (DBS).
See this image and copyright information in PMC

References

    1. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020. 10.1001/jama.2020.6775 - DOI - PMC - PubMed
    1. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Critical Care Medicine. 2020; 1 10.1097/CCM.0000000000004363 - DOI - PMC - PubMed
    1. Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Medicine. 2020. [cited 20 Apr 2020]. 10.1007/s00134-020-06033-2 - DOI - PMC - PubMed
    1. Ottestad W, Søvik S. COVID-19 patients with respiratory failure: what can we learn from aviation medicine? British Journal of Anaesthesia. 2020. [cited 20 Apr 2020]. 10.1016/j.bja.2020.04.012 - DOI - PMC - PubMed
    1. Mahjoub Y, Rodenstein DO, Jounieaux V. Severe Covid-19 disease: rather AVDS than ARDS? Critical Care. 2020;24 10.1186/s13054-020-02972-w - DOI - PMC - PubMed