The purpose of this study is to characterize microvascular reactivity on the forearm muscle using non-invasive near-infrared spectroscopy in critically ill COVID-19 patients, and to correlate its alterations with 28-day mortality in ICU COVID-19 patients.
After giving consent to participate in the study, the subjects included in the study will
undergo a 15-minute measurement of tissue oxygen saturation (StO2) measured non-invasively on
the forearm by means of near-infrared spectroscopy (NIRS). Once a baseline stable StO2 value
is obtained, a provocative test, consisting of a transient vascular occlusion, will be
performed. The test will allow the obtention of a local metabolic rate, and a StO2 recovery
rate after the ischemic stimulus. This StO2 recovery rate will be considered as a reflection
of the endothelial health of the patient.
Patients will be studied as soon as possible after admission to the ICU, and followed-up
until ICU discharge or death.
Device: Vascular occlusion test
The ischemic challenge will consist in a standardized Vascular Occlusion Test (VOT), as previously described in the literature. Briefly, a blood pressure cuff will be placed proximal to the forearm, and rapidly inflated at 40 mmHg above systolic pressure, and kept inflated during three minutes. Then the cuff will be rapidly deflated. The resulting deoxygenation (DeO2) and reoxygenation (ReO2) slopes will be reported as change in O2 saturation over time.
Inclusion Criteria:
- Recent diagnosis of SARS-CoV2 infection
- Arterial hypoxemia and bilateral alveolar infiltrates, not explained by cardiac
dysfunction or fluid overload.
Exclusion Criteria:
- Severe peripheral vasculopathy
- Raynaud's syndrome
- Skin lesions or trauma in upper limbs interfering the placement of NIRS probe and/or
the occlusion tourniquet
- Deep venous thrombosis in the upper limbs
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Hospital de Clinicas da UNICAMP
Campinas, Sao Paulo, Brazil
Hospital Das Clínicas University of Sao Paulo Medical School
Sao Paulo, Brazil
Hospital General de México
México, Mexico
Institut d'Investigació i Innovació Parc Taulí
Sabadell, Barcelona, Spain
Hospital Clínic i Provincial de Barcelona
Barcelona, Spain
Hospital Parc Salut Mar
Barcelona, Spain
Hospital Vall d'Hebron
Barcelona, Spain
Jaume Mesquida, MD, PhD
+34 937231010 - 21155
jmesquida@tauli.cat
Jaume Mesquida, MD, PhD, Principal Investigator
Corporacion Parc Tauli