Abstract
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. 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. 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. Critical COVID-19 patients under mechanical ventilation seem to have higher red blood cell velocity than severe non-ventilated patients.
Highlights
The most severe Coronavirus disease 19 (COVID-19) patients require critical care support in dedicated intensive care units (ICUs) to deliver oxygen supplemental and mechanical ventilation [1]
As the database of this study was authorized by the CNIL, we cannot make available data without prior agreement of the CNIL
Duration from the symptoms onset to ICU admission was similar between groups (8 [4,5,6,7,8,9,10] vs 7 [5,6,7,8,9,10] days; p = 0.894 for critical and severe groups, respectively)
Summary
The most severe Coronavirus disease 19 (COVID-19) patients require critical care support in dedicated intensive care units (ICUs) to deliver oxygen supplemental and mechanical ventilation [1]. During COVID-19 outbreak, the Surviving Sepsis Campaign emitted recommendations on the management of critically ill patients: oxygen supplemental is required when oxygen saturation (SpO2) is lower than 90% [2] and, if acute hypoxemic failure persists, tracheal intubation and mechanical ventilation are recommended. Timing for intubation and invasive ventilation in COVID-19 patients is a subject of debate [6]. In this new disease, microcirculatory impairment might explain disease progression and differences between invasively and non-invasively ventilated patients. The objective was to compare sublingual microcirculation parameters of critically ill patients according to the severity of the disease
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call