The Role of Dysbiosis in Critically Ill Patients With COVID-19 and Acute Respiratory Distress Syndrome

Frontiers in Medicine

Iole Brunetti¹  Andrea Fedele¹  Denise Battaglini²  Nicolò Patroniti³  Paolo Pelosi³  Chiara Robba³  Lorenzo Ball³  Antonio Vena⁴  Matteo Bassetti⁵  Daniele Roberto Giacobbe⁵  Sebastian Trancǎ⁶  Antoni Torres Martí⁷  Vincenzo Di Pilato⁸  Samir Giuseppe Sukkar⁹  Patricia Rieken Macedo Rocco^1,10 

[1] Anesthesia and Intensive Care, Ospedale Policlinico San Martino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) per l'Oncologia e le Neuroscienze, Genova, Italy;Anesthesia and Intensive Care, Ospedale Policlinico San Martino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) per l'Oncologia e le Neuroscienze, Genova, Italy;Department of Medicine, University of Barcelona, Barcelona, Spain;Anesthesia and Intensive Care, Ospedale Policlinico San Martino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) per l'Oncologia e le Neuroscienze, Genova, Italy;Department of Surgical Sciences and Integrated Diagnostics (DISC), Università degli Studi di Genova, Genova, Italy;Clinica Malattie Infettive, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) per l'Oncologia e le Neuroscienze, Genova, Italy;Clinica Malattie Infettive, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) per l'Oncologia e le Neuroscienze, Genova, Italy;Dipartimento di Scienze della Salute (DISSAL), Università degli Studi di Genova, Genova, Italy;Department of Anesthesia and Intensive Care II, Clinical Emergency County Hospital of Cluj, Iuliu Hatieganu, University of Medicine and Pharmacy, Cluj-Napoca, Romania;Anaesthesia and Intensive Care 1, Clinical Emergency County Hospital Cluj-Napoca, Cluj-Napoca, Romania;Department of Medicine, University of Barcelona, Barcelona, Spain;Division of Animal Experimentation, Department of Pulmonology, Hospital Clinic, Barcelona, Spain;Centro de Investigacion en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain;Institut d'investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain;Department of Surgical Sciences and Integrated Diagnostics (DISC), Università degli Studi di Genova, Genova, Italy;Dietetics and Clinical Nutrition Unit, Ospedale Policlinico San Martino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) per l'Oncologia e le Neuroscienze, Genova, Italy;Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil;COVID-19-Network, Ministry of Science, Technology, Innovation and Communication, Brasilia, Brazil;

关键词: microbiota;    dysbiosis;    ARDS;    critical care;    infection;    COVID-19;   

DOI  :  10.3389/fmed.2021.671714

来源: Frontiers

【 摘 要 】

In late December 2019, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) quickly spread worldwide, and the syndrome it causes, coronavirus disease 2019 (COVID-19), has reached pandemic proportions. Around 30% of patients with COVID-19 experience severe respiratory distress and are admitted to the intensive care unit for comprehensive critical care. Patients with COVID-19 often present an enhanced immune response with a hyperinflammatory state characterized by a “cytokine storm,” which may reflect changes in the microbiota composition. Moreover, the evolution to acute respiratory distress syndrome (ARDS) may increase the severity of COVID-19 and related dysbiosis. During critical illness, the multitude of therapies administered, including antibiotics, sedatives, analgesics, body position, invasive mechanical ventilation, and nutritional support, may enhance the inflammatory response and alter the balance of patients' microbiota. This status of dysbiosis may lead to hyper vulnerability in patients and an inappropriate response to critical circumstances. In this context, the aim of our narrative review is to provide an overview of possible interaction between patients' microbiota dysbiosis and clinical status of severe COVID-19 with ARDS, taking into consideration the characteristic hyperinflammatory state of this condition, respiratory distress, and provide an overview on possible nutritional strategies for critically ill patients with COVID-19-ARDS.

【 授权许可】

CC BY