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A new pilot from the Icahn School of Medicine in Mount Sinai suggests that COVID-19 causes significant dilation of the blood vessels of the lung, especially the capillaries.
NEW YORK, August 20, 2020 / PRNewswire-PRWeb / – A new pilot examination of the Icahn School of Medicine on Mount Sinai suggests that COVID-19 causes significant dilation of the blood vessels of the lung, especially capillaries. This vasodilation contributes to the very low oxygen levels observed in COVID-19 respiratory failure and also helps explain why the disease behaves differently from traditional acute respiratory misery syndrome (EDS). The exam was published in the American Journal of Respiratory and Critical Care Medicine.
In traditional RIAS, lung inflammation causes the leakage of the pulmonary blood vessels that flood the lungs with fluid, making them stiff and impairing oxygenation. Many patients with COVID-19 pneumonia have severe hypoxemia which is particularly disproportionate to the degree of pulmonary stiffness. This disconnect between fuel exchange and lung mechanics in COVID-19 pneumonia raised the question of whether hypoxemia mechanisms in COVID-19 differ from those of traditional LRA.
The discovery was fortuitous. First, the researchers evaluated brain blood in patients with mechanically ventilated COVID-19 with an altered intellectual state to look for, among other things, abnormalities compatible with a stroke. They used a transcranial Doppler (TCD) robot, NovaSignal’s Lucid Robotic System, to perform a “bubble study,” which is a painless, non-invasive ultrasound technique.
“It is remarkable that a diagnostic device used to examine the brain can give us an idea of the pathophysiology of lung disease. The merit of using this specific formula was that automated tracking allowed providers to evaluate brain blood and minimize the possibility of exposure to COVID -19,” said Alexandra Reynolds, MD, assistant professor of neurosurgery and neurology at Icahn School of Medicine in Mount Sinai and director of tele-neurocritical care for the Mount Sinai fitness formula.
During this study, a restless saline solution (a saline solution with tiny microbubbles) is injected into the patient’s vein and TCD is used to find out if those microbubbles appear to be in the blood vessels of the brain. In general circumstances, these microbubbles would move to the right side of the cinput, enter the blood vessels of the lungs, and eventually filter through the pulmonary capillaries, because the diameter of the microbubbles is greater than the diameter of the pulmonary capillaries. If microbubbles are detected in the blood vessels of the brain, this implies that there is a gap in the cinput, so that blood can pass from the right side to the left side of the cinput without passing through the lungs, or that the capillaries in the lungs are usually dilated, allowing the microbubbles to pass.
In the pilot study, 18 patients mechanically ventilated with severe COVID-19 pneumonia underwent a TCD bubble study. Fifteen of the 18 (83%) patients had detectable microbubbles, indicating the presence of abnormally dilated pulmonary blood vessels. The number of microbubbles detected through TCD correlated with the severity of hypoxemia, indicating that pulmonary vasodilations would possibly be disproportionate hypoxemia observed in many patients with COVID-19 pneumonia. Previous studies have shown that only 26% of patients with traditional SDS have microbubbles in a bubble study; In addition, the number of these microbubbles does not correlate with the severity of hypoxemia, implying that pulmonary vascular dilations are not a primary mechanism of hypoxemia in traditional SED.
“It is increasingly transparent that the virus is wreaked havoc on the pulmonary vascular formula in various ways. This test is helping the strange phenomenon observed in some patients with COVID-19, known as “good hypoxia”, where oxygen grades are very high. patients don’t seem to have difficulty breathing. If these effects are shown in larger studies, the transit of pulmonary microbubbles can potentially serve as a marker of the severity of the disease or even as a substitute criterion in coVID-19 cure trials Future studies examining the use of pulmonary vascular constrictors in this patient population are possibly justified, says lead writer Hooman Poor , MD, assistant professor of medicine (pneumology, intensive care and sleep medicine) at Icahn School of Medicine in Mount Sinai. and director of Pulmonary Vascular Disease at Mount Sinai – National Jewish Institute of Respiratory Health.
Since then, the pilot examination has expanded to gather knowledge from approximately 80 patients, adding those with a less serious disease, and will assess the severity of the transit of microbubbles and their diversifications as the disease progresses.
About The Mount Sinai Health System The Mount Sinai Health System is New York City’s largest college medical formula, comprising 8 hospitals, a leading medical school, and an extensive network of outpatient practices throughout the New York City metropolitan area. Mount Sinai is a national and foreign source of education, translational studies and unheard-of discoveries, and collaborative clinical leadership to ensure we provide the highest quality of care, from prevention to the remedy of the most serious and complex human diseases. The healthcare formula includes more than 7,200 physicians and has a physically powerful and ever-expanding network of multi-specialized services, adding more than 400 outpatient practice locations in the five counties of New York, Westchester and Long Island. Mount Sinai Hospital ranks 14th in the “Table of Honor” of the country’s top 20 hospitals through the U.S. News-World Report and the Icahn School of Medicine among the 20 most sensible medical schools in the country. Mount Sinai Health System hospitals are regionally classified by specialty through U.S. News – World Report.
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