Angiotensin-converting enzyme 2 (ACE2) receptor of severe acute respiratory syndrome coronavirus 2 is involved in baroreflex control mechanisms. We hypothesize that severe coronavirus infectious disease 2019 (COVID-19) patients may show an alteration in baroreflex-mediated heart rate changes in response to arterial hypotension. A pilot study was conducted to assess the response to hypotension in relation to continuous venovenous hemodiafiltration (CVVHDF) in critically ill patients with PCR-confirmed COVID-19 (from February to April 2020) and in critically ill non-COVID-19 patients with sepsis (from February 2018 to February 2020). The endpoint was a change in the heart rate in response to CVVHDF-induced hypotension. The association between COVID-19 status and heart rate change was estimated using linear regression. The study population included 6 COVID-19 patients (67% men; age 58 (53–64) years) and 12 critically ill non-COVID-19 patients (58% men; age 67 (51–71) years). Baseline characteristics, laboratory findings, hemodynamic parameters, and management before CVVHDF-induced hypotension were similar between the two groups, with the exception of a higher positive end-expiratory pressure and doses of propofol and midazolam administered in COVID-19 patients. Changes in the heart rate were significantly lower in COVID-19 patients as compared to critically ill non-COVID-19 patients (−7 (−9; −2) vs. 2 (2;5) bpm, p = 0.003), while the decrease in mean arterial blood pressure was similar between groups. The COVID-19 status was independently associated with a lower change in the heart rate (−11 (−20; −2) bpm; p = 0.03). Our findings suggest an inappropriate heart rate response to hypotension in severe COVID-19 patients compared to critically ill non-COVID-19 patients.
【저자키워드】 COVID-19, critically ill patients, baroreflex, dysautonomic response, 【초록키워드】 ACE2, coronavirus, Sepsis, Infectious disease, Laboratory, Critically ill, Characteristics, management, Patient, Linear regression, age, mechanisms, receptor, change, parameters, COVID-19 patients, association, hemodynamic, dose, blood pressure, propofol, COVID-19 patient, Positive end-expiratory pressure, Critically ill patient, acute respiratory syndrome, Non-COVID-19 patients, Endpoint, two groups, study population, pilot study, enzyme, PCR-confirmed COVID-19, significantly lower, Administered, decrease, involved, conducted, changes in, groups, bpm, non-COVID-19 patient, severe COVID-19 patient, 【제목키워드】 heart, response, Hypotension, Rate, Ill,