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1.
Pacientes con HAP en época de COVID-19 Dra. Pilar Escribano Subías
Dra Pilar Escribano Subias
COVID 19 y HAP
2.
Pacientes con HAP en época de COVID-19 Dra. Pilar Escribano Subías
Cel endoteliales de
arterias y venas
Células musculares
lisas arteriales
Epitelio bronquial y
neumocitos tipo 2
Epitelio del intestino
delgado
Células inmunes
Muthiah Vaduganathan, 2020
3.
Pacientes con HAP en época de COVID-19 Dra. Pilar Escribano Subías
4.
Pacientes con HAP en época de COVID-19 Dra. Pilar Escribano Subías
Small sized arterioles (open arrow) with complete luminal thrombosis
and occlusive thromboses of intraseptal capillaries (closed arrow).
Medium size arteries (asterisks) with complete luminal thrombosis,
one of them showing stratification of inflammatory cells
on a destroyed endothelial layer (triangle).
5.
Pacientes con HAP en época de COVID-19 Dra. Pilar Escribano Subías
6.
Pacientes con HAP en época de COVID-19 Dra. Pilar Escribano Subías
Unidad multidisciplinar de HP del 12 de Octubre
7.
Pacientes con HAP en época de COVID-19 Dra. Pilar Escribano Subías
1) 50 % neumonías bilateral y multilobar
- 2 Distress respiratorio
- 3 oxigeno de alto flujo
- 3 insuficiencia respiratoria crónica
2) 50% ingreso hospitalario
3) No exitus, no ingreso en UCI
Tratamiento de la HAP
ARE ARE+ PDE5 Triple tto BCC
8.
Pacientes con HAP en época de COVID-19 Dra. Pilar Escribano Subías
Unidad multidisciplinar de HP del 12 de Octubre. HPTBEC
PATIENT
(Sex)
Patient 1
(Female)
Patient 2
(Female)
Patient 3
(Male)
PAST MEDICAL HISTORY
Hypertension N Y N
Diabetes mellitus IFG N N
Dyslipidemia N Y N
Smoking habit N N Former
Other significant comorbidities CKD-Dialysis
Bronchiectasis
None COPD (GOLD B)
Hydrocephalus (VP shunt)
Previous pneumonic events 2012. ICU admission None 2018. ICU admission
Age at PH diagnosis* (years) 41 68 43
PTE (date) Y (2017) N Y (2017)
BPA start date 2017 2019 2019
BPA procedures (n) 3 3 4
BPA program completed N N N
PH medical treatment PDi + ERA PDi Riociguat + ERA + PGa
Medical treatment (Others) Epoetin ACEI Loop diuretic+MRA+Inhalers
Domiciliary oxygen Y N Y
Oral anticoagulation Dicumarin Dicumarin Dicumarin
Hemodynamic data 1st
RHC Last RHC 1st
RHC Last RHC 1st
RHC Last RHC
RAP (mmHg) 20 13 12 3 16 5
MPAP (mmHg) 66 44 58 29 67 51
PVR (WU) 27 10.8 8.35 5.52 17 6
CI (l/min/m2
) 1.5 2.02 3.1 2.37 2 3.6
SvO (%) 61.9 60.0 57.0 55.0 47.6 64
Todos neumonía
2 bilobar y bilateral
1 unilobar
flujo de O2
Ingreso Hosp
No UCI
9.
Pacientes con HAP en época de COVID-19 Dra. Pilar Escribano Subías
Hipótesis
1) Disminución receptores ACE2
2) Remodelado vascular/ Inflamación perivascular
3) Tto especifico de la disfunción endotelial
ARE
PDE5
Prostaciclinas
4) Anticoagulación
10.
Pacientes con HAP en época de COVID-19 Dra. Pilar Escribano Subías
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