Peripheral microcirculatory alterations are associated with the severity of acute respiratory distress syndrome in COVID-19 patients admitted to intermediate respiratory and intensive care units.

BACKGROUND: COVID-19 is primarily a respiratory disease; however, there is also evidence that it causes endothelial damage in the microvasculature of several organs. The aim of the present study is to characterize in vivo the microvascular reactivity in peripheral skeletal muscle of severe COVID-19 patients. METHODS: This is a prospective observational study carried out in Spain, Mexico and Brazil. Healthy subjects and severe COVID-19 patients admitted to the intermediate respiratory (IRCU) and intensive care units (ICU) due to hypoxemia were studied. Local tissue/blood oxygen saturation (StO2) and local hemoglobin concentration (THC) were non-invasively measured on the forearm by near-infrared spectroscopy (NIRS). A vascular occlusion test (VOT), a three-minute induced ischemia, was performed in order to obtain dynamic StO2 parameters: deoxygenation rate (DeO2), reoxygenation rate (ReO2), and hyperemic response (HAUC). In COVID-19 patients, the severity of ARDS was evaluated by the ratio between peripheral arterial oxygen saturation (SpO2) and the fraction of inspired oxygen (FiO2) (SF ratio). RESULTS: Healthy controls (32) and COVID-19 patients (73) were studied. Baseline StO2 and THC did not differ between the two groups. Dynamic VOT-derived parameters were significantly impaired in COVID-19 patients showing lower metabolic rate (DeO2) and diminished endothelial reactivity. At enrollment, most COVID-19 patients were receiving invasive mechanical ventilation (MV) (53%) or high-flow nasal cannula support (32%). Patients on MV were also receiving sedative agents (100%) and vasopressors (29%). Baseline StO2 and DeO2 negatively correlated with SF ratio, while ReO2 showed a positive correlation with SF ratio. There were significant differences in baseline StO2 and ReO2 among the different ARDS groups according to SF ratio, but not among different respiratory support therapies. CONCLUSION: Patients with severe COVID-19 show systemic microcirculatory alterations suggestive of endothelial dysfunction, and these alterations are associated with the severity of ARDS. Further evaluation is needed to determine whether these observations have prognostic implications. These results represent interim findings of the ongoing HEMOCOVID-19 trial. Trial registration ClinicalTrials.gov NCT04689477 . Retrospectively registered 30 December 2020.

In vivo time-domain diffuse correlation spectroscopy above the water absorption peak.

Time-domain diffuse correlation spectroscopy (TD-DCS) is a newly emerging optical technique that exploits pulsed, yet coherent light to non-invasively resolve the blood flow in depth. In this work, we have explored TD-DCS at longer wavelengths compared to those previously used in literature (i.e., 750-850 nm). The measurements were performed using a custom-made titanium-sapphire mode-locked laser, operating at 1000 nm, and an InGaAs photomultiplier as a detector. Tissue-mimicking phantoms and in vivo measurements during arterial arm cuff occlusion in n=4 adult volunteers were performed to demonstrate the proof of concept. We obtained a good signal-to-noise ratio, following the hemodynamics continuously with a relatively fast (1 Hz) sampling rate. In all the experiments, the auto-correlation functions show a decay rate approximately five-fold slower compared to shorter wavelengths. This work demonstrates the feasibility of in vivo TD-DCS in this spectral region and its potentiality for biomedical applications.

In vivo time-gated diffuse correlation spectroscopy at quasi-null source-detector separation.

We demonstrate time domain diffuse correlation spectroscopy at quasi-null source-detector separation by using a fast time-gated single-photon avalanche diode without the need of time-tagging electronics. This approach allows for increased photon collection, simplified real-time instrumentation, and reduced probe dimensions. Depth discriminating, quasi-null distance measurement of blood flow in a human subject is presented. We envision the miniaturization and integration of matrices of optical sensors of increased spatial resolution and the enhancement of the contrast of local blood flow changes.

Time domain diffuse correlation spectroscopy with a high coherence pulsed source: in vivo and phantom results.

Diffuse correlation spectroscopy (DCS), combined with time-resolved reflectance spectroscopy (TRS) or frequency domain spectroscopy, aims at path length (i.e. depth) resolved, non-invasive and simultaneous assessment of tissue composition and blood flow. However, while TRS provides a path length resolved data, the standard DCS does not. Recently, a time domain DCS experiment showed path length resolved measurements for improved quantification with respect to classical DCS, but was limited to phantoms and small animal studies. Here, we demonstrate time domain DCS for in vivo studies on the adult forehead and the arm. We achieve path length resolved DCS by means of an actively mode-locked Ti:Sapphire laser that allows high coherence pulses, thus enabling adequate signal-to-noise ratio in relatively fast (~1 s) temporal resolution. This work paves the way to the translation of this approach to practical in vivo use.

SU-E-T-111: Single Line Multi-Detector Scintillation Dosimetry: Demonstration of Feasibility.

PURPOSE: Obtain feasibility data on the use of multiple scintillators on a single optical line for dose measurements. METHODS: A CsI (Tl doped) crystal and a plastic (Rexon Inc, Rp-408) scintillator detectors, both transparent, were attached to the end of a fiberoptic line and connected to an Ocean Optics USB-2000 spectrometer. After baseline spectra, spectra with the two scintillators adjacent to each other and then separated by a 7.6 cm plexiglass spacer were obtained. Irradiations were performed using 6 MV X-ray beam from a Varian EX linear accelerator. Utilizing the baseline spectra the dose received by each scintillator were calculated from the measured spectral peaks of the linear scintillator assemblies. Linearity tests were performed by varying dose and the dose rate in a homogeneous radiation field covering both scintillators. Unequal doses were delivered to the scintillator by gradually closing the collimator from one direction, blocking one detector at a time. Doses to the scintillators were modulated by different amount of solid water placed over the two detectors, as well. RESULTS: Measured scintillation spectra agreed with the published spectra. The spectra did not change with depth in the phantom. The multi-scintillator system response was strictly linear between 1.67 and 40 MUs, (approx. 1.3 to 31 cGy) and dose rate independent between 100 to 600 MU/min. The profile curves obtained by closing the collimator agreed with qualitatively expected curves. Doses measured under different phantom thicknesses were in good agreement with ion chamber measurements on the same locations (+/- 3%). The linearity and dose rate independence allow absolute dose calibration for given beam energies and scintillator arrangement. CONCLUSIONS: Multi-probe scintillation dosimetry along a single optical fiber is possible in therapeutic irradiation conditions. This is feasible by using signals from multiple select scintillators with distinct spectroscopic responses arranged along an optical fiber.