Comment on: Intrapulmonary shunt and alveolar dead space in a cohort of patients with acute COVID-19 pneumonitis and early recovery

Ackermann, Maximilian; Tafforeau, Paul; Brunet, Joseph; Kamp, Jan C.; Werlein, Christopher; Kühnel, Mark Philipp; Jacob, Joseph; Walsh, Claire; Lee, Peter; Welte, Tobias; Jonigk, Danny

doi:10.1183/13993003.02121-2022

Eur Respir J

2023

DOI: 10.1183/13993003.02121-2022

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Comment on: Intrapulmonary shunt and alveolar dead space in a cohort of patients with acute COVID-19 pneumonitis and early recovery

Maximilian Ackermann

Paul Tafforeau

Joseph Brunet

et al.

Abstract: It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online.

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Increased intrapulmonary shunt and alveolar dead space post-COVID-19

Farrow,

Robles,

Prisk

et al. 2023

Journal of Applied Physiology

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Increased intrapulmonary shunt(QS/Qt) and alveolar dead space(VD/VT) are present in early recovery from COVID-19. We hypothesized patients recovering from severe-critical acute illness(NIH category 3-5) would have greater and longer-lasting increased QS/Qt and VD/VT than patients with mild-moderate acute illness(NIH 1-2). Methods: 59 unvaccinated patients (33 male, age 52[38-61] years, BMI 28.8[25.3-33.6] kg/m2; median[IQR], 44 previous mild-moderate COVID-19, and 15 severe-critical disease), were studied 15-403 days post-acute SARS-CoV-2 infection. Breathing ambient air, steady-state mean alveolar PCO2 and PO2 were recorded simultaneously with arterial PO2/PCO2 yielding aAPCO2, AaPO2, and from these, QS/Qt%, VD/VT%, and relative alveolar ventilation (40 mmHg/PACO2, VArel) calculated. Results: Median PaCO2 was 39.4[35.6-41.1] mmHg, PaO2 92.3[87.1-98.2mmHg; PACO2 32.8[28.6-35.3] mmHg, PAO2 112.9[109.4-117.0] mmHg, AaPO2 18.8[12.6-26.8] mmHg, aAPCO2 5.9 [4.3-8.0] mmHg, QS/Qt 4.3 [2.1-5.9] % and VD/VT16.6 [12.6-24.4] %. Only 14% of patients had normal QS/Qt and VD/VT;1% increased QS/Qt but normal VD/VT; 49% normal QS/Qt and elevated VD/VT;36% both abnormal QS/Qt and VD/VT. Previous severe-critical COVID-19 predicted increased QS/Qt (2.69 [0.82-4.57]% per category severity [95% CI], p<0.01), but not VD/VT. Increasing age weakly predicted increased VD/VT (1.6 [0.1-3.2]% per decade, p<0.04). Time since infection, BMI and comorbidities were not predictors (all p > 0.11). VArel was increased in most patients. Conclusions: In our population, recovery from COVID-19 was associated with increased QS/Qt in 37% of patients, increased VD/VT in 86%, and increased alveolar ventilation up to ~13 months post infection. NIH severity predicted QS/Qt but not elevated VD/VT. Increased VD/VT suggests pulmonary micro-vascular pathology persists post COVID-19 in most patients.

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Increased intrapulmonary shunt and alveolar dead space post-COVID-19

Farrow,

Robles,

Prisk

et al. 2023

Journal of Applied Physiology

View full text Add to dashboard Cite

show abstract

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Comment on: Intrapulmonary shunt and alveolar dead space in a cohort of patients with acute COVID-19 pneumonitis and early recovery

Abstract: It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online.

Cited by 1 publication

References 10 publications

Increased intrapulmonary shunt and alveolar dead space post-COVID-19

Increased intrapulmonary shunt and alveolar dead space post-COVID-19

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