DETECTION AND QUANTIFICATION OF MICROCIRCULATORY DYSFUNCTION IN SEVERE COVID-19 NOT REQUIRING MECHANICAL VENTILATION: A THREE-ARM COHORT STUDY.

IF 2.7 3区医学 Q2 CRITICAL CARE MEDICINE

SHOCK Pub Date : 2024-11-01 Epub Date: 2024-08-12 DOI:10.1097/SHK.0000000000002451

Stanislas Abrard, Thomas Coquet, Jérémie Riou, Emmanuel Rineau, Jeanne Hersant, Antoine Vincent, Julien Cordoval, Matthias Jacquet-Lagrèze, Bernard Allaouchiche, Anne-Claire Lukaszewicz, Samir Henni

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引用次数: 0

Abstract

Abstract: Aim: To identify and describe microcirculatory dysfunction (MD) in severe COVID-19 cases. Methods: This prospective, cohort study evaluated microvascular function in COVID-19 patients with acute respiratory failure not requiring mechanical ventilation and compared it with that of non-COVID-19 intensive care unit (ICU)-matched controls. A validation cohort included healthy, comorbidity-free patients. The primary outcome compared tissue oxygen resaturation slope (rStO 2 ) in COVID-19 patients and non-COVID ICU controls. rStO 2 was measured post a 3-min vaso-occlusive test during post-occlusive reactive hyperemia (PORH). Additionally, microvascular reactivity was assessed using perfusion index (PI) during PORH and laser speckle contrast imaging post iontophoresis with acetylcholine (ACH), sodium nitroprusside (SNP), and sublingual microcirculation. Results: Overall, 75 patients (25 per cohort) were included. COVID-19 patients exhibited greater severity than ICU controls, as indicated by their SOFA scores (4.0 [3.0; 4.0] vs. 1.0 [0; 1.0], P < 0.001) and PaO 2 /FiO 2 ratios (113 [82; 150] vs. 443 [348; 533], P < 0.001). No significant difference was observed in rStO 2 between the groups. COVID-19 patients showed longer time in reaching peak PI ( P = 0.025), reduced vasodilation with ACH and SNP ( P = 0.010 and P = 0.018, respectively), and increased microvascular density ( P = 0.019) compared to non-COVID-19 ICU controls. Conclusion: We observed evidence of MD in COVID-19 patients through various microcirculatory parameters. This study's reproducible multimodal approach facilitates acute MD detection across multiple clinical applications. Limitations included the observational design, limited statistical power, single-time microvascular measurements, varying illness severity among groups, and possible influences of treatments and vaccinations on MD. Trial registration : Clinical-Trials.gov (NCT04773899).

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无需机械通气的严重 COVID-19 患者微循环功能障碍的检测和量化：三臂队列研究。

目的：确定并描述严重 COVID-19 病例中的微循环功能障碍（MD）：这项前瞻性队列研究评估了不需要机械通气的急性呼吸衰竭 COVID-19 患者的微血管功能，并将其与非 COVID-19 重症监护室（ICU）匹配对照组的微血管功能进行了比较。验证队列包括无合并症的健康患者。主要结果是比较 COVID-19 患者和非 COVID ICU 对照组的组织氧饱和度斜率（rStO2）。此外，还利用 PORH 期间的灌注指数（PI）以及乙酰胆碱（ACH）、硝普钠（SNP）离子透入后的激光斑点对比成像和舌下微循环对微血管反应性进行了评估：共纳入 75 例患者（每组 25 例）。COVID-19 患者的 SOFA 评分（4.0 [3.0; 4.0] vs. 1.0 [0; 1.0]，P < 0.001）和 PaO2/FiO2 比率（113 [82; 150] vs. 443 [348; 533]，P < 0.001）显示，COVID-19 患者的病情比 ICU 对照组严重。两组之间的 rStO2 无明显差异。与非 COVID-19 ICU 对照组相比，COVID-19 患者达到 PI 峰值的时间更长（p = 0.025），ACH 和 SNP 的血管舒张作用减弱（分别为 p = 0.010 和 p = 0.018），微血管密度增加（p = 0.019）：结论：我们通过各种微循环参数观察到 COVID-19 患者存在 MD 的证据。这项研究的多模态可重复性方法有助于在多种临床应用中检测急性 MD。局限性包括：观察性设计、有限的统计能力、单次微血管测量、各组间病情严重程度不同以及治疗和疫苗接种可能对MD产生的影响：试验注册：Clinical-Trials.gov (NCT04773899)。

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来源期刊

SHOCK 医学-外科

CiteScore

6.20

自引率

3.20%

发文量

199

审稿时长

1 months

期刊介绍： SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.