The pathophysiology of 'happy' hypoxemia in COVID-19.
Sebastiaan DhontEric DeromEva Van BraeckelPieter DepuydtBart N LambrechtPublished in: Respiratory research (2020)
The novel coronavirus disease 2019 (COVID-19) pandemic is a global crisis, challenging healthcare systems worldwide. Many patients present with a remarkable disconnect in rest between profound hypoxemia yet without proportional signs of respiratory distress (i.e. happy hypoxemia) and rapid deterioration can occur. This particular clinical presentation in COVID-19 patients contrasts with the experience of physicians usually treating critically ill patients in respiratory failure and ensuring timely referral to the intensive care unit can, therefore, be challenging. A thorough understanding of the pathophysiological determinants of respiratory drive and hypoxemia may promote a more complete comprehension of a patient's clinical presentation and management. Preserved oxygen saturation despite low partial pressure of oxygen in arterial blood samples occur, due to leftward shift of the oxyhemoglobin dissociation curve induced by hypoxemia-driven hyperventilation as well as possible direct viral interactions with hemoglobin. Ventilation-perfusion mismatch, ranging from shunts to alveolar dead space ventilation, is the central hallmark and offers various therapeutic targets.
Keyphrases
- respiratory failure
- coronavirus disease
- sars cov
- mechanical ventilation
- healthcare
- extracorporeal membrane oxygenation
- primary care
- end stage renal disease
- newly diagnosed
- ejection fraction
- public health
- respiratory syndrome coronavirus
- chronic kidney disease
- prognostic factors
- peritoneal dialysis
- intellectual disability
- case report
- acute respiratory distress syndrome
- intensive care unit
- autism spectrum disorder