Non‐invasive hemodynamic profile of early COVID‐19 infection

• Published in: Physiological reports Vol. 8; no. 20; pp. e14628 - n/a
• Main Authors: Busana, Mattia, Schiavone, Marco, Lanfranchi, Antonio, Battista Forleo, Giovanni, Ceriani, Elisa, Beatrice Cogliati, Chiara, Gasperetti, Alessio
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.10.2020; John Wiley and Sons Inc; Wiley
• Subjects: acute respiratory failure; Adult; Betacoronavirus; Blood pressure; Body temperature; Chronic obstructive pulmonary disease; Coronavirus Infections - physiopathology; COVID-19; Diabetes; Disease; Echocardiography; Gas exchange; Heart rate; Hemodynamics; Hemodynamics - physiology; Humans; hyperdynamic state; Hypoxemia; Infections; Male; Middle Aged; Original Research; Oxygenation; Pandemics; Physiology; Pneumonia, Viral - physiopathology; Population; Pulmonary arteries; Pulmonary artery; SARS-CoV-2; Sepsis; Stroke; Vasodilation; Ventilators; COVID-19; hypoxemia; acute respiratory failure; hyperdynamic state; hemodynamics; echocardiography
• ISSN: 2051-817X
• DOI: 10.14814/phy2.14628

Introduction Little is known about the systemic and pulmonary macrohemodynamics in early COVID‐19 infection. Echocardiography may provide useful insights into COVID‐19 physiopathology. Methods Twenty‐three COVID‐19 patients were enrolled in a medical ward. Gas exchange, transthoracic echocardiographic, and hemodynamic variables were collected. Results Mean age was 57 ± 17 years. The patients were hypoxemic (PaO2/FiO2 = 273.0 ± 102.6 mmHg) and mildly hypocapnic (PaCO2 = 36.2 ± 6.3 mmHg, pH = 7.45 ± 0.03). Mean arterial pressure was decreased (86.7 [80.0–88.3] mmHg). Cardiac index was elevated (4.32 ± 0.90 L∙min‐1∙m‐2) and the resulting systemic vascular resistance index low (1,458 [1358–1664] dyn∙s∙cm‐5∙m‐2). The right heart was morphologically and functionally normal, with pulmonary artery pressure (PAPm, 18.0 ± 2.9 mmHg) and Total Pulmonary Resistances (TPR, 2.3 [2.1–2.7] mmHg∙l‐1∙min‐1) within normal limits. When stratifying for SVRI, patients with an SVRI value below the cohort median had also more severe oxygenation impairment and lower TPR, despite a similar degree of CXR infiltrates. Oxygen delivery index in this group resulted supranormal. Conclusions In the early stages of COVID‐19 infection the hemodynamic profile is characterized by a hyperdynamic circulatory state with high CI and low SVRI, while the right heart is functionally unaffected. Our findings suggest that hypoxemia, viral sepsis or peripheral shunting are possible mechanisms for the vasodilation that dominates at this stage of the disease and may itself worsen the gas exchange. Early COVID‐19 infection is characterized by a hyperdynamic circulatory state, with low systemic resistances. Moreover, pulmonary pressures and pulmonary resistances are low. This suggests two main findings: at least in the initial stage, pulmonary vasodilation prevails over vasoconstriction and the hyperdynamic state may worsen the severe ventilation‐perfusion mismatch.