Pathophysiology of Hypoxemia in COVID-19 Lung Disease

doi:10.1016/j.ccm.2022.11.007

Review

. 2023 Jun;44(2):239-248.

doi: 10.1016/j.ccm.2022.11.007. Epub 2022 Nov 23.

Pathophysiology of Hypoxemia in COVID-19 Lung Disease

Kai E Swenson¹, Charles C Hardin²

Affiliations

¹ Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Bulfinch 148, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: keswenson@mgh.harvard.edu.
² Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Bulfinch 148, 55 Fruit Street, Boston, MA 02114, USA.

PMID: 37085217
PMCID: PMC9682047
DOI: 10.1016/j.ccm.2022.11.007

Review

Pathophysiology of Hypoxemia in COVID-19 Lung Disease

Kai E Swenson et al. Clin Chest Med. 2023 Jun.

. 2023 Jun;44(2):239-248.

doi: 10.1016/j.ccm.2022.11.007. Epub 2022 Nov 23.

Authors

Kai E Swenson¹, Charles C Hardin²

Affiliations

¹ Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Bulfinch 148, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: keswenson@mgh.harvard.edu.
² Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Bulfinch 148, 55 Fruit Street, Boston, MA 02114, USA.

PMID: 37085217
PMCID: PMC9682047
DOI: 10.1016/j.ccm.2022.11.007

Abstract

As the pandemic has progressed, our understanding of hypoxemia in coronavirus disease 2019 (COVID-19) lung disease has become more nuanced, although much remains to be understood. In this article, we review ventilation-perfusion mismatching in COVID-19 and the evidence to support various biologic theories offered in explanation. In addition, the relationship between hypoxemia and other features of severe COVID-19 lung disease such as respiratory symptoms, radiographic abnormalities, and pulmonary mechanics is explored. Recognizing and understanding hypoxemia in COVID-19 lung disease remains essential for risk stratification, prognostication, and choice of appropriate treatments in severe COVID-19.

Keywords: ARDS; COVID-19; Hypoxemia; SARS-CoV-2.

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References

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[1] Guan W.J., Ni Z.Y., Hu Y., et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–1720. - PMC - PubMed

[2] Guan W.J., Ni Z.Y., Hu Y., et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–1720. - PMC - PubMed

[3] Xie J., Covassin N., Fan Z., et al. Association between hypoxemia and mortality in patients with COVID-19. Mayo Clin Proc. 2020;95(6):1138–1147. - PMC - PubMed

[4] Xie J., Covassin N., Fan Z., et al. Association between hypoxemia and mortality in patients with COVID-19. Mayo Clin Proc. 2020;95(6):1138–1147. - PMC - PubMed

[5] Waldrop G., Safavynia S.A., Barra M.E., et al. Prolonged unconsciousness is common in COVID-19 and associated with hypoxemia. Ann Neurol. 2022;91(6):740–755. - PMC - PubMed

[6] Waldrop G., Safavynia S.A., Barra M.E., et al. Prolonged unconsciousness is common in COVID-19 and associated with hypoxemia. Ann Neurol. 2022;91(6):740–755. - PMC - PubMed

[7] Estenssoro E., Loudet C.I., Dubin A., et al. Clinical characteristics, respiratory management, and determinants of oxygenation in COVID-19 ARDS: a prospective cohort study. J Crit Care. 2022;71:154021. - PMC - PubMed

[8] Estenssoro E., Loudet C.I., Dubin A., et al. Clinical characteristics, respiratory management, and determinants of oxygenation in COVID-19 ARDS: a prospective cohort study. J Crit Care. 2022;71:154021. - PMC - PubMed

[9] Gattinoni L., Coppola S., Cressoni M., et al. COVID-19 does not lead to a "typical" acute respiratory distress syndrome. Am J Respir Crit Care Med. 2020;201(10):1299–1300. - PMC - PubMed

[10] Gattinoni L., Coppola S., Cressoni M., et al. COVID-19 does not lead to a "typical" acute respiratory distress syndrome. Am J Respir Crit Care Med. 2020;201(10):1299–1300. - PMC - PubMed

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Pathophysiology of Hypoxemia in COVID-19 Lung Disease

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Pathophysiology of Hypoxemia in COVID-19 Lung Disease

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