Changes in some vascular biomarkers in patients with severe COVID-19 during prone positioning on various types of respiratory support

INTRODUCTION. The severe acute respiratory syndrome-related coronavirus-2 (SARS-Cov2) virus is able to interfere with the interaction of angiotensin-converting enzyme with its receptor. Pronation can affect not only the state of gas exchange during Coronavirus disease 2019 (COVID-19), but also blood circulation, as well as the exchange of vasoactive substances. Hemocirculation disorders are essential in the pathogenesis of severe COVID-19.

The OBJECTIVE was to assess the level of vascular biomarkers in patients with pneumonia caused by SARS-CoV-2 during proning against the background of various respiratory support

METHODS AND MATERIALS. The study included 3 groups of patients depending on respiratory support. The first group consisted of 16 patients who received respiratory support with oxygen at a flow of 5–7 liters per minute. The second group included 15 patients who underwent non-invasive lung ventilation. The third group of 16 patients underwent invasive lung ventilation. Blood tests of endothelin-1, B-natriuretic hormone were performed using an enzyme immunoassay kit. The amount of nitrite (NO₂) and nitrates (NO₃) was determined by the method based on the enzymatic conversion of nitrate to nitrite with the participation of the enzyme nitrate reductase. The reaction recorded the colorimetric concentration of nitrite using the azo dye formed in the Griess reaction.

RESULTS. In patients with respiratory oxygen support during pronation, a decrease in the blood level of brain natriuretic peptide was detected. During the prone position maneuver in patients on mechanical ventilation, the concentration of nitrites increased. In an intergroup comparison, in patients of group 3 relative to groups 1 and 2, NO₂ and NO₃ indicators changed against the background of proning.

СONCLUSION. The increased invasiveness of respiratory support in patients with COVID-19 when performing prone positioning is associated with changes in blood levels of nitrites and nitrates.

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