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

• Published in: PloS one Vol. 16; no. 2; p. e0246636
• Main Authors: Abou-Arab, Osama, Beyls, Christophe, Khalipha, Abdelilah, Guilbart, Mathieu, Huette, Pierre, Malaquin, Stéphanie, Lecat, Benoit, Macq, Pierre-Yves, Roger, Pierre Alexandre, Haye, Guillaume, Bernasinski, Michaël, Besserve, Patricia, Soriot-Thomas, Sandrine, Jounieaux, Vincent, Dupont, Hervé, Mahjoub, Yazine
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08.02.2021; Public Library of Science (PLoS)
• Subjects: Aged; Anesthesiology; Automation; Biology and Life Sciences; Blood flow; Blood pressure; Capillary pressure; Carbon Dioxide - metabolism; Cardiac output; Coronaviruses; COVID-19; COVID-19 - physiopathology; COVID-19 - virology; Critical care; Critical Illness; Critically ill; Draft (gas flow); Editing; Electronic mail; Female; Gases; Health aspects; Heart rate; Hemodynamics; Hospitals; Humans; Intensive care; Intensive Care Units; Intubation; Life Sciences; Male; Mechanical ventilation; Medicine; Medicine and Health Sciences; Microcirculation; Microcirculation - physiology; Microvasculature; Microvessels - physiopathology; Middle Aged; Oxygen; Oxygen - metabolism; Oxygen saturation; Partial Pressure; Patients; Physical Sciences; Physiological aspects; Prospective Studies; SARS-CoV-2 - physiology; Sepsis; Software; Statistical analysis; Statistics; Ventilation; Ventilators; Ventricle; Viral diseases; France; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0246636

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.