Pathophysiology of hypoxemia in mechanically-ventilated patients with COVID-19 : A computed tomography study
Copyright © 2023 Elsevier B.V. All rights reserved..
The pathogenesis of hypoxemia during acute respiratory distress syndrome caused by SARS-CoV-2 infection (C-ARDS) is debated. Some observations led to hypothesize ventilation to perfusion mismatch, rather than anatomical shunt, as the main determinant of hypoxemia. In this observational study 24 C-ARDS patients were studied 1 (0-1) days after intubation. Patients underwent a CT scan analysis to estimate anatomical shunt and a clinical test to measure venous admixture at two fractions of inspired oxygen (FiO2), to eliminate oxygen-responsive mechanisms of hypoxemia (ventilation to perfusion mismatch and diffusion limitation). In 10 out of 24 patients venous admixture was higher than anatomical shunt both at clinical (≈50 %) and 100 % FiO2. These patients were ventilated with a higher PEEP and had lower amount of anatomical shunt compared with patients with venous admixture equal/lower than anatomical shunt. In a subset of C-ARDS patients early after endotracheal intubation, hypoxemia might be explained by an abnormally high perfusion of a relatively low anatomical shunt.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:318 |
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| Enthalten in: |
Respiratory physiology & neurobiology - 318(2023) vom: 12. Dez., Seite 104162 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Santini, Alessandro [VerfasserIn] |
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| Links: |
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| Themen: |
Acute respiratory distress syndrome |
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| Anmerkungen: |
Date Revised 13.10.2023 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1016/j.resp.2023.104162 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM362012164 |
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| 245 | 1 | 0 | |a Pathophysiology of hypoxemia in mechanically-ventilated patients with COVID-19 |b A computed tomography study |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a Copyright © 2023 Elsevier B.V. All rights reserved. | ||
| 520 | |a The pathogenesis of hypoxemia during acute respiratory distress syndrome caused by SARS-CoV-2 infection (C-ARDS) is debated. Some observations led to hypothesize ventilation to perfusion mismatch, rather than anatomical shunt, as the main determinant of hypoxemia. In this observational study 24 C-ARDS patients were studied 1 (0-1) days after intubation. Patients underwent a CT scan analysis to estimate anatomical shunt and a clinical test to measure venous admixture at two fractions of inspired oxygen (FiO2), to eliminate oxygen-responsive mechanisms of hypoxemia (ventilation to perfusion mismatch and diffusion limitation). In 10 out of 24 patients venous admixture was higher than anatomical shunt both at clinical (≈50 %) and 100 % FiO2. These patients were ventilated with a higher PEEP and had lower amount of anatomical shunt compared with patients with venous admixture equal/lower than anatomical shunt. In a subset of C-ARDS patients early after endotracheal intubation, hypoxemia might be explained by an abnormally high perfusion of a relatively low anatomical shunt | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute respiratory distress syndrome | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Hypoxia | |
| 650 | 4 | |a Shunt | |
| 650 | 4 | |a Ventilation-perfusion mismatch | |
| 650 | 4 | |a Ventilation-perfusion ratio | |
| 700 | 1 | |a Protti, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Ferrari, Michele |e verfasserin |4 aut | |
| 700 | 1 | |a Pennati, Francesca |e verfasserin |4 aut | |
| 700 | 1 | |a Pugliese, Luca |e verfasserin |4 aut | |
| 700 | 1 | |a Mercalli, Cesare |e verfasserin |4 aut | |
| 700 | 1 | |a Aliverti, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Cecconi, Maurizio |e verfasserin |4 aut | |
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