Assessment of Peripheral Perfusion in Severe Acute Respiratory Syndrome Corona virus 2 (Sars-Cov-2) Infection: An Exploratory Analysis with Near-Infrared Spectroscopy

Author(s): Guilherme Martins de Souza, Vinícius Barbosa Galindo, Daniel Lima da Rocha, Felipe Souza Lima Vianna, Renato Carneiro de Freitas Chaves, Carla Dantas Malossi, Alice Medeiros Vieira, Thais Dias Midega, Flávia Manfredi Cavalcanti, Murillo Santucci Cesar Assunção, Leonardo Van de Wiel Barros Urbano Andari, Roberto Rabello Filho, Thiago Domingos Corrêa

Purpose: To investigate clinical and laboratory tissue perfusion in addition to near-infrared spectroscopy (NIRS) static and dynamic-derived parameters in critically ill COVID-19 patients.

Methods: A cross-sectional single-center exploratory study was performed. Twenty adult patients with confirmed COVID-19 admitted to the intensive care unit (ICU) within 24 hours were prospectively included in this study. A control group without COVID-19 was composed by forty patients included in recently published study. Accessed NIRS-derived parameters included basal tissue oxygen saturation (StO2), descending slope (%/min), ascending slope (%/min), maximum value of StO2 (StO2max), recovery time (s) and the area under the curve of reactive hyperemia.

Results: The median (IQR) age of included patients was 58 (46-69) years. Patients with COVID-19 presented higher SAPS 3 score [50 (46-53) vs. 45 (30-53), p=0.04] compared with control patients. Patients with SARS-CoV-2 infection showed higher StO2 min [60 (49-79) vs. 54 (48-58) %; p=0.04] and lower descending slope [5.7 (3.4-8.8) vs. 8.1 (6.4-9.7) %/min; p<0.01] compared with ICU patients without COVID-19. Basal StO2 [80 (74-90) vs. 82 (76-86) %; p=0.89], StO2 max [(91 (83-95) vs. 90 (84-94) %; p=0.86], ascending slope [2.0 (1.1-2.9) vs. 2.2 (1.5-3.3) %/min; p=0.43], recovery time [14.5 (12.0-22.0) vs. 21.5 (14.3-28.3) s; p=0.13] and hyperemia area [10.3 (5.8-13.0) vs. 8.6 (4.0-14.3); p=0.55] did not differ between, respectively, COVID-19 and control groups.

Conclusion: Severe COVID-19 patients exhibited a lower rate of oxygen extraction by peripheral tissues than non-COVID-19 critically ill patients, which may represent an adaptive mechanism to hypoxemia. This hypothesis needs to be further investigated.