Causes of Hypoxemia in COVID-19 Acute Respiratory Distress Syndrome: A Combined Multiple Inert Gas Elimination Technique and Dual-energy Computed Tomography Study

ConclusionsThese data support the hypothesis of a highly multifactorial genesis of hypoxemia. Moreover, recent evidence from post-mortem studies (i.e., opening of intrapulmonary bronchopulmonary anastomosis) may explain the findings regarding the postpulmonary shunting. The hyperperfusion might be related to the disease severity.Editor ’s PerspectiveWhat We Already Know about This TopicAlthough different mechanisms of hypoxemia in COVID-19 acute respiratory distress syndrome (ARDS) have been suggested, there is ongoing debate regarding the underlying pathophysiologyThe multiple inert gas elimination technique (MIGET) and dual-energy computed tomography (DECT) are state-of-the art methods to analyze the functional and anatomical substrate of lung diseaseWhat This Article Tells Us That Is NewThe authors found shunt, ventilation –perfusion mismatch, and potentially diffusion limitation or postpulmonary shunting in COVID-19 ARDSThe authors also found an excess of blood volume compared to the tissue in well-aerated regions but not with atelectasisThe findings support the concept of a multifactorial genesis of hypoxemia, in which alveolar factors, typical of ARDS, are combined with vascular factors, more typical of pulmonary embolism, all of which contribute to the overall severity of the disease
Source: Anesthesiology - Category: Anesthesiology Source Type: research