Abstract:Patients with COVID-19 are typically characterized by severe lung injury with the development of acute respiratory failure. However, in some patients, subjective well-being may remain relatively satisfactory for a long time and, despite severe hypoxemia, they do not complain of shortness of breath. Case report. We observed a 65-year-old man hospitalized with severe SARS-CoV-2 pneumonia, low level of blood oxygen saturation, but at the same time without complaints of shortness of breath. Only as the disease pro… Show more
Acute respiratory failure (ARF) is the leading cause of death in hospitalized patients with severe forms of COVID-19. At the beginning of COVID-19 pandemic the starting respiratory protocol suggested early use of intubation and artificial lung ventilation (ALV) in patients with severe pneumonia complicated by ARF. However, after the analysis of the published studies it was noted that the pathophysiology of the development of ARF in COVID-19 had features that determine the atypical clinical pattern – “silent hypoxemia”. This leads to the late onset of respiratory support (RS) and, as a result, to the lower effectiveness of non-invasive RS methods. This article discusses the creation of an algorithm for the early use of various non-invasive RS methods in patients with COVID-19 complicated by ARF, that will decrease the frequency of hospitalization to the Intensive care units, tracheal intubation and ALV, reduce the duration of treatment and improve prognosis.
Acute respiratory failure (ARF) is the leading cause of death in hospitalized patients with severe forms of COVID-19. At the beginning of COVID-19 pandemic the starting respiratory protocol suggested early use of intubation and artificial lung ventilation (ALV) in patients with severe pneumonia complicated by ARF. However, after the analysis of the published studies it was noted that the pathophysiology of the development of ARF in COVID-19 had features that determine the atypical clinical pattern – “silent hypoxemia”. This leads to the late onset of respiratory support (RS) and, as a result, to the lower effectiveness of non-invasive RS methods. This article discusses the creation of an algorithm for the early use of various non-invasive RS methods in patients with COVID-19 complicated by ARF, that will decrease the frequency of hospitalization to the Intensive care units, tracheal intubation and ALV, reduce the duration of treatment and improve prognosis.
Dyspnea may not be a major symptom of the disease. There are many reports that some patients with COVID-19 did not complain of dyspnea. There is no consensus on the clinical significance of hypoxemia without dyspnea. Several studies suggest that patients with hypoxemia without dyspnea are not protected against the development of adverse COVID-19 outcomes. It is unclear whether hypoxemia with and without dyspnea are two distinct COVID-19 phenotypes or two phases of the disease. There is currently no consensus on the terminology of this condition, its definition, and its mechanisms of formation. It has not been established whether hypoxemia without dyspnea is associated with a favorable outcome of the disease or not. The question of the absence of respiratory response to hypoxia improves the prognosis in such patients remains unresolved. Analysis of currently available data on the mechanisms of hypoxemia development and related manifestations of dyspnea in SARS-CoV-2 virus infection. “Silent hypoxemia” can be observed both in the initial manifestations of respiratory failure and in progression of the disease. Clinical significance of “silent hypoxemia” is that the decrease in physiologic responses and the absence of dyspnea allow patients to feel normal, thus denying the severity of their condition and masking the true severity of the disease. In addition, in elderly patients and patients with diabetes mellitus, suppression of respiratory function in response to hypoxia and the development of “silent hypoxemia” with rapid decompensation should be expected. The attitude to patients with “asymptomatic carriage” of the virus should be reconsidered and comprehensive monitoring of such patients with mandatory pulse oximetry or arterial blood gas test composition should be carried out.
Гострий респіраторний дистрес-синдром (ГРДС) та дихальна недостатність є основними загрозливими станами у хворих із COVID-19. Основною причиною є насамперед порушення перфузії легень. Анатомічні передумови для позитивного тиску у кінці видиху (ПТКВ) (некардіогенний набряк легень, ателектаз і, отже, можливість рекрутування) відсутні. Неінвазивна вентиляція легень може усунути гіпоксемію і знизити інспіраторні зусилля. Інакше слід розглянути можливість використання механічної вентиляції для запобігання самоіндукованому пошкодженню легень. Ці характеристики пов’язані з помітним порушенням механіки дихання, підвищеним тиском вуглекислого газу артеріальної крові. Провідною характеристикою прогресування COVID-19 є поступовий перехід від набряку або ателектазу до менш оборотних структурних змін легень, а саме до фіброзу. Порушується механіка дихання, підвищується тиск вуглекислого газу в артеріальній крові, знижується здатність дихальної мускулатури та відсутня реакція на ПТКВ у положенні на животі.
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