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Respir Res . The pathophysiology of 'happy' hypoxemia in COVID-19

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  • Respir Res . The pathophysiology of 'happy' hypoxemia in COVID-19


    Respir Res


    . 2020 Jul 28;21(1):198.
    doi: 10.1186/s12931-020-01462-5.
    The pathophysiology of 'happy' hypoxemia in COVID-19


    Sebastiaan Dhont 1 , Eric Derom 2 3 , Eva Van Braeckel 2 3 , Pieter Depuydt 2 4 , Bart N Lambrecht 2 3 5



    Affiliations

    Abstract

    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.

    Keywords: COVID-19; Dyspnea; Gas exchange; Hypoxemia; Respiratory failure; SARS-CoV-2.

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