Assessment of Peripheral Perfusion in Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-cov-2) Infection: An Exploratory Analysis With Near-infrared Spectroscopy

Abstract

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 III 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.