COVID-19: a hypothesis regarding the ventilation-perfusion mismatch

Santamarina, Mario; Boisier, Dominique; Contreras, Roberto; Baque, Martiniano; Volpacchio, Mariano; Beddings, Ignacio

doi:10.1186/s13054-020-03125-9

Cited by 80 publications

(85 citation statements)

References 11 publications

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“…Whether the microvascular involvement represents a disease-specific feature of COVID-19 disease is debated [ 27 , 45 ]. In our study, ventilatory ratio was slightly higher in COVID-19 patients than in ARDS of other causes.…”

Section: Discussionmentioning

confidence: 99%

Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies

et al. 2020

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Background Whether respiratory physiology of COVID-19-induced respiratory failure is different from acute respiratory distress syndrome (ARDS) of other etiologies is unclear. We conducted a single-center study to describe respiratory mechanics and response to positive end-expiratory pressure (PEEP) in COVID-19 ARDS and to compare COVID-19 patients to matched-control subjects with ARDS from other causes. Methods Thirty consecutive COVID-19 patients admitted to an intensive care unit in Rome, Italy, and fulfilling moderate-to-severe ARDS criteria were enrolled within 24 h from endotracheal intubation. Gas exchange, respiratory mechanics, and ventilatory ratio were measured at PEEP of 15 and 5 cmH 2 O. A single-breath derecruitment maneuver was performed to assess recruitability. After 1:1 matching based on PaO 2 /FiO 2 , FiO 2 , PEEP, and tidal volume, COVID-19 patients were compared to subjects affected by ARDS of other etiologies who underwent the same procedures in a previous study. Results Thirty COVID-19 patients were successfully matched with 30 ARDS from other etiologies. At low PEEP, median [25th–75th percentiles] PaO 2 /FiO 2 in the two groups was 119 mmHg [101–142] and 116 mmHg [87–154]. Average compliance (41 ml/cmH 2 O [32–52] vs. 36 ml/cmH 2 O [27–42], p = 0.045) and ventilatory ratio (2.1 [1.7–2.3] vs. 1.6 [1.4–2.1], p = 0.032) were slightly higher in COVID-19 patients. Inter-individual variability (ratio of standard deviation to mean) of compliance was 36% in COVID-19 patients and 31% in other ARDS. In COVID-19 patients, PaO 2 /FiO 2 was linearly correlated with respiratory system compliance ( r = 0.52 p = 0.003). High PEEP improved PaO 2 /FiO 2 in both cohorts, but more remarkably in COVID-19 patients ( p = 0.005). Recruitability was not different between cohorts ( p = 0.39) and was highly inter-individually variable (72% in COVID-19 patients and 64% in ARDS from other causes). In COVID-19 patients, recruitability was independent from oxygenation and respiratory mechanics changes due to PEEP. Conclusions Early after establishment of mechanical ventilation, COVID-19 patients follow ARDS physiology, with compliance reduction related to the degree of hypoxemia, and inter-individually variable respiratory mechanics and recruitability. Physiological differences between ARDS from COVID-19 and other causes appear small.

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Section: Discussionmentioning

confidence: 99%

Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies

et al. 2020

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“…The respiratory physiotherapy in ICU contributes to improve oxygenation in mechanically ventilated patients with severe acute respiratory failure or acute respiratory distress syndrome [13]. As it is known, COVID -19 patients can present a severe ventilation/perfusion mismatch, which could be overcome by positioning the patient in prone position [14]. In this connection, this treatment strategy also matters to the physiotherapist practice.…”

Section: Physiotherapy and Covid-19 Spreadmentioning

confidence: 99%

COVID-19 Pandemic: A Physiotherapy Update

et al. 2020

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Physiotherapists have an essential role in the recovery of patients who require hospital care and/or in intensive care units. However, so far, there is little discussion in literature about the interventions by physiotherapists together with multidisciplinary teams in hospital units that receive COVID-19 patients. In this perspective article, we discuss the role and importance of physiotherapy in the management of COVID-19 cases with focus on patients admitted to hospitals.

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“…In addition, the data obtained are difficult to interpret in patients that have significant ventila-tion perfusion (V/Q) mismatch, as is seen frequently during COVID-19, with the potential to generate falsely elevated values. 28 Besides, indirect calorimetry may increase the risk of breaking the ventilatory circuit, generating aerosols, and exposing the healthcare worker to contamination. 23 Patients with severe COVID-19 exhibit impaired oxygenation and carbon dioxide production, associated with shunting, V/Q mismatch, and potentially increased dead space.…”

Section: Nutrition Assessmentmentioning

confidence: 99%

Lessons Learned in Nutrition Therapy in Patients With Severe COVID‐19

Ochoa

Cárdenas

Goiburu

et al. 2020

J Parenter Enteral Nutr

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The coronavirus disease 2019 (COVID-19) pandemic has reached worldwide, and until a vaccine is found, it will continue to cause significant morbidity and mortality. The clinical presentation of COVID-19 ranges from that of being asymptomatic to developing a fatal illness characterized by multiple organ involvement. Approximately 20% of the patients will require hospitalization; onequarter of hospitalized patients will develop severe COVID-19 requiring admission to the intensive care unit, most frequently, with acute respiratory failure. An ongoing effort is being made to identify the patients that will develop severe COVID-19. Overall, patients present with 3 different phenotypes of nutrition risk: (1) the frail older patient, (2) the patient with severe ongoing chronic illness, and (3) the patient with severe and morbid obesity. These 3 phenotypes represent different nutrition risks and diverse nutrition interventions. This article explores the different potential approaches to nutrition intervention in patients with COVID-19, evaluating, in this process, the challenges faced in the implementation of guidelines written by different societies.

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COVID-19: a hypothesis regarding the ventilation-perfusion mismatch

Cited by 80 publications

References 11 publications

Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies

Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies

COVID-19 Pandemic: A Physiotherapy Update

Lessons Learned in Nutrition Therapy in Patients With Severe COVID‐19

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