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
- PMID: 32723327
- DOI: 10.1186/s12931-020-01462-5
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.