An Evolving Clinical Need: Discordant Oxygenation Measurements of Intubated COVID-19 Patients

Rubano, Jerry A.; Maloney, Lauren; Simon, Jessica; Rutigliano, Daniel N.; Botwinick, Isadora; Jawa, Randeep S.; Shapiro, Marc J.; Vosswinkel, James A.; Talamini, Mark A.; Kaushansky, Kenneth

doi:10.1007/s10439-020-02722-7

Cited by 10 publications

(8 citation statements)

References 13 publications

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“…In one study [ 378 ], central venous oxygen saturation (ScvO 2 ) was 66% for healthy controls, 33% for acute COVID-19 survivors, and 18% for those who died from COVID-19. We note that conventional fingertip-type pulse oximeters, while reasonably accurate, mostly estimate arterial O 2 levels [ 380 ], so would not necessarily pick up this kind of phenomenon; indeed this may account for the discordance [ 381 , 382 ] between pulse oximetry and arterial blood gas measurements. Cerebral oximetry [ 383 ] may provide a truer assessment if non-invasive measures are desired.…”

Section: Evidence For Capillary Blockage From Venous O 2 ...mentioning

confidence: 99%

The potential role of ischaemia–reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications

Kell

2022

Biochemical Journal

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Ischaemia–reperfusion (I–R) injury, initiated via bursts of reactive oxygen species produced during the reoxygenation phase following hypoxia, is well known in a variety of acute circumstances. We argue here that I–R injury also underpins elements of the pathology of a variety of chronic, inflammatory diseases, including rheumatoid arthritis, ME/CFS and, our chief focus and most proximally, Long COVID. Ischaemia may be initiated via fibrin amyloid microclot blockage of capillaries, for instance as exercise is started; reperfusion is a necessary corollary when it finishes. We rehearse the mechanistic evidence for these occurrences here, in terms of their manifestation as oxidative stress, hyperinflammation, mast cell activation, the production of marker metabolites and related activities. Such microclot-based phenomena can explain both the breathlessness/fatigue and the post-exertional malaise that may be observed in these conditions, as well as many other observables. The recognition of these processes implies, mechanistically, that therapeutic benefit is potentially to be had from antioxidants, from anti-inflammatories, from iron chelators, and via suitable, safe fibrinolytics, and/or anti-clotting agents. We review the considerable existing evidence that is consistent with this, and with the biochemical mechanisms involved.

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Section: Evidence For Capillary Blockage From Venous O 2 ...mentioning

confidence: 99%

The potential role of ischaemia–reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications

Kell

2022

Biochemical Journal

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“…4 Penanganan ARDS sebagian besar bersifat suportif dengan suplementasi oksigen. 4,5 Modalitas terapi oksigen dapat diberikan secara non-invasif via nasal kanul ataupun sungkup muka bilevel positive airway pressure, dapat juga secara invasif melalui intubasi endotrakea dengan ventilasi mekanik. Kebutuhan penggunaan dan titrasi suplementasi oksigen sangat bergantung pada evaluasi status oksigenasi darah.…”

Section: Pendahuluanunclassified

Tinjauan Pustaka: Alkalosis Respiratorik pada COVID-19: Sleeping with the "Silent Devil."

Dewi¹,

Panji²

2022

jap

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Dewasa ini krisis pertumbuhan penyakit coronavirus disease (COVID-19) telah menekan sistem kesehatan secara global bahkan lebih dari sebelumnya, menyebabkan kebutuhan peningkatan kapasitas unit perawatan intensif dalam menangani jumlah pasien kritis yang meningkat secara tajam. Gagal napas pada COVID-19 diperburuk oleh keadaan hipoksemia dan dapat memburuk menjadi acute respiratory distress syndrome (ARDS) yang segera membutuhkan terapi suplementasi oksigen. Menilai kebutuhan memulai terapi oksigen dapat dilakukan salah satunya dengan analisis gas darah untuk mengevaluasi gangguan asam basa terutama pada perjalanan awal COVID-19 simtomatis berat. Silent hypoxemia sebagai gejala COVID-19 yang mematikan merupakan sebuah tantangan dalam kegawatdaruratan COVID-19. Hipoksemia berat akibat hiperventilasi tanpa gangguan pernapasan akan menunjukkan gambaran hasil analisis gas darah berupa alkalosis respiratorik sebagai upaya kompensasi penurunan kadar PaCO 2 untuk meningkatkan saturasi. Pergeseran kurva disosiasi ke kiri menyebabkan peningkatan afinitas Hb-O 2 untuk memfasilitasi kebutuhan oksigen. Maka dari itu, tenaga kesehatan harus memperhatikan bukan hanya keadaan umum pasien melainkan juga laju pernapasan dan melihat tanda hiperventilasi untuk mengetahui gangguan asam basa melalui analisis gas darah agar dapat mencegah komplikasi alkalosis respiratorik.

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“…Generally, Gerbich antibodies do not result in severe hemolytic reactions. As a result, some researchers believe that excessive interpretation of the oxygen dissociation curve is inappropriate (114). If the oxygen dissociation curve is used exclusively in medical diagnosis, it may result in an error.…”

Section: The Oxygen Dissociation Curve Was Insufficiently Interpretablementioning

confidence: 99%

COVID-19: Invades Erythrocytes through Plasmodium Falciparum Antigen and Complement-Like System

Liu

2021

Preprint

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Malaria symptoms are very similar to those of COVID-19, and infections can be symptomatic or asymptomatic. Common immunodominant epitopes are shared by the SARS-CoV-2 proteins and the Plasmodium falciparum antigen. Through bioinformatics methods such as domain search, this study discovered that the S, ORF3a proteins contained Plasmodium antigens rich in tryptophan and threonine. ORF3a, ORF8, S, and N and others also had more extended autotransporter domains. The Plasmodium antigen of S protein contained a C1q domain capable of binding to the complement receptor 1 on the red blood cell membrane. ORF3a contained the Plasmodium antigen EBA-175 domain, which was capable of binding to glycophorin A on the red blood cell membrane. S and ORF3a were bound to band 4.1 to anchor on the erythrocyte membrane skeleton, respectively. The Membrane attack complex component of the S protein formed fusion pores on the red blood cell membrane. Then it injected viral genetic material into the mature red blood cell. ORF3a used a thiol-activated cytolysin domain to create hemolytic pores in the red blood cell membrane. The coagulation factor calcium ions were involved in the red blood cell invasion process. The invasion would have no discernible hemolysis or hypoxia reactions. According to the Plasmodium antigen type for SARS-COV-2, the blood cells of people with blood types A and Knops were susceptible to attack by SARS-COV-2 virus proteins.

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An Evolving Clinical Need: Discordant Oxygenation Measurements of Intubated COVID-19 Patients

Cited by 10 publications

References 13 publications

The potential role of ischaemia–reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications

The potential role of ischaemia–reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications

Tinjauan Pustaka: Alkalosis Respiratorik pada COVID-19: Sleeping with the "Silent Devil."

COVID-19: Invades Erythrocytes through Plasmodium Falciparum Antigen and Complement-Like System

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