Endothelial shear stress enhancements: a potential solution for critically ill Covid-19 patients

Abstract

Most critically ill Covid-19 patients succumb to multiple organ failure and/or sudden cardiac arrest (SCA) as a result of comorbid endothelial dysfunction disorders which had probably aggravated by conventional mechanical assist devices. Even worse, mechanical ventilators prevent the respiratory pump from performing its crucial function as a potential generator of endothelial shear stress (ESS) which controls microcirculation and hemodynamics since birth. The purpose of this work is to bring our experience with ESS enhancement and pulmonary vascular resistance (PVR) management as a potential therapeutic solution in acute respiratory distress syndrome (ARDS). We propose a non-invasive device composed of thoracic and infradiaphragmatic compartments that will be pulsated in an alternating frequency (20/40 bpm) with low-pressure pneumatic generator (0.1–0.5 bar). Oxygen supply, nasogastric with, or without endotracheal tubes are considered.

Time to Resuscitate Cardiopulmonary Resuscitation: The 3R/CPR Refill-Recoil-Rebound

“…Moreover, as occurs in postcardiotomy syndrome [54,55], E-CPR provides a steady-flow mode of perfusion that further aggravates endothelial dysfunction. This may be aggravated by vasopressors which increase myocardial oxygen consumption and mechanical ventilation which suppresses the important role of the respiratory pump as a potential generator of ESS, most likely to end in multiple organ failure [56].…”

“…Therefore, the employment of CFR, which is a non-invasive device unlike ECPR, can mobilize a massive amount of stagnant blood volume (≥4 liters) in a pulsatile mode promoting ESS with improvement of microcirculation and cellular metabolism during refractory and postarrest phases [27]. In addition, the CFR device's vest, associated with a passive oxygen insufflation device serves as a noninvasive mechanical ventilator with a nasogastric tube could be useful during refractory cardiac arrest and in postarrest to prevent excessive ventilation in maintaining the pulmonary ESS [56].…”

Time to resuscitate cardiopulmonary resuscitation! The 3R/CPR: Refill-Recoil-Rebound.

“…Also, relying on vasopressors to improve hemodynamics worsen endothelial dysfunction conditions by increasing vascular resistances and myocardial oxygen consumption, most likely to end in organ failure and requirement of CAD. This may be worsened by suppressing the important role of the respiratory pump as a master-key circulatory driving force and a potential generator of ESS [75].…”

“…Accordingly, unlike ECPR, the employment of a non-invasive CFR device [27], can mobilize a massive amount of stagnant blood volume (≥4 liters) in a pulsatile mode promoting ESS with improvement microcirculation and cellular metabolism, regardless to heartbeat. In addition, the CFR device's vest, associated with a passive oxygen insu ation device serves as a noninvasive mechanical ventilator with a nasogastric tube could be useful during refractory cardiac arrest and in postarrest to prevent excessive ventilation in maintaining the pulmonary ESS [75].…”

Time to resuscitate cardiopulmonary resuscitation! The 3R/CPR: Refill-Recoil-Rebound.

“…In addition to the 3R/CPR that can improve results of chest compression, we believe that the rapid installation of the CFR device regardless to ROSC, can mobilize massive amount of stagnant blood volume (≥4 liters) in a pulsatile noninvasive manner which can globally improve the outcome of SCA. In addition, the CFR device's vest, associated with a passive oxygen insufflation device serves as a noninvasive mechanical ventilator with a nasogastric tube could be useful during refractory cardiac arrest and in postarrest to prevent excessive ventilation in maintaining the pulmonary ESS [85,86].…”