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Review
. 2020 Sep 24;21(1):249.
doi: 10.1186/s12931-020-01520-y.

Misconceptions of pathophysiology of happy hypoxemia and implications for management of COVID-19

Martin J Tobin  1 , Amal Jubran  2 , Franco Laghi  2
Affiliations
Review

Misconceptions of pathophysiology of happy hypoxemia and implications for management of COVID-19

Martin J Tobin et al. Respir Res. .

Abstract

In the article "The pathophysiology of 'happy' hypoxemia in COVID-19," Dhont et al. (Respir Res 21:198, 2020) discuss pathophysiological mechanisms that may be responsible for the absence of dyspnea in patients with COVID-19 who exhibit severe hypoxemia. The authors review well-known mechanisms that contribute to development of hypoxemia in patients with pneumonia, but are less clear as to why patients should be free of respiratory discomfort despite arterial oxygen levels commonly regarded as life threatening. The authors propose a number of therapeutic measures for patients with COVID-19 and happy hypoxemia; we believe readers should be alerted to problems with the authors' interpretations and recommendations.

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Conflict of interest statement

MJT receives royalties for two books on critical care published by McGraw-Hill, Inc., New York.

Comment in

References

    1. Dhont S, Derom E, Van Braeckel E, Depuydt P, Lambrecht BN. The pathophysiology of ‘happy’ hypoxemia in COVID-19. Respir Res. 2020;21:198. doi: 10.1186/s12931-020-01462-5. - DOI - PMC - PubMed
    1. Tobin MJ, Laghi F, Jubran A. Why COVID-19 silent hypoxemia is baffling to physicians. Am J Respir Crit Care Med. 2020;202(3):356–360. doi: 10.1164/rccm.202006-2157CP. - DOI - PMC - PubMed
    1. Tobin MJ, Laghi F, Jubran A. Caution about early intubation and mechanical ventilation in COVID-19. Ann Intensive Care. 2020;10(1):78. doi: 10.1186/s13613-020-00692-6. - DOI - PMC - PubMed
    1. Tobin MJ, Laghi F, Jubran A. P-SILI is not justification for intubation of COVID-19 patients. Ann Intensive Care. 2020;10(1):105. doi: 10.1186/s13613-020-00724-1. - DOI - PMC - PubMed
    1. Laghi F, Tobin MJ. Indications for mechanical ventilation. In: Tobin MJ, editor. Principles and practice of mechanical ventilation. 3. New York: McGraw-Hill, Inc.; 2013. pp. 101–135.