Transpulmonary pressure in SARS-CoV-2-associated acute respiratory distress syndrome: a single-center observational study

Ramin, Séverin; Charbit, Jonathan; Dagod, Geoffrey; Girard, Mehdi; Jaber, Samir; Capdevila, Xavier

doi:10.1186/s13054-020-03129-5

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…In early descriptions of critically ill hypoxemic patients with COVID-19 ( 23 , 24 ), roughly 20% had “normal to near normal” static total respiratory system compliance (C st ) of 70–90 ml/cmH 2 O, with an average of 50 ml/cmH 2 O. Neither of these two small studies reported any correlation of C st with pulmonary radiological abnormalities.…”

Section: Lung Parenchyma Compliance and Hypoxemia In Covid-19 Lung Injurymentioning

confidence: 99%

The Pathophysiology and Dangers of Silent Hypoxemia in COVID-19 Lung Injury

2021

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The ongoing coronavirus disease (COVID-19) pandemic has been unprecedented on many levels, not least of which are the challenges in understanding the pathophysiology of these new critically ill patients. One widely reported phenomenon is that of a profoundly hypoxemic patient with minimal to no dyspnea out of proportion to the extent of radiographic abnormality and change in lung compliance. This apparently unique presentation, sometimes called “happy hypoxemia or hypoxia” but better described as “silent hypoxemia,” has led to the speculation of underlying pathophysiological differences between COVID-19 lung injury and acute respiratory distress syndrome (ARDS) from other causes. We explore three proposed distinctive features of COVID-19 that likely bear on the genesis of silent hypoxemia, including differences in lung compliance, pulmonary vascular responses to hypoxia, and nervous system sensing and response to hypoxemia. In the context of known principles of respiratory physiology and neurobiology, we discuss whether these particular findings are due to direct viral effects or, equally plausible, are within the spectrum of typical ARDS pathophysiology and the wide range of hypoxic ventilatory and pulmonary vascular responses and dyspnea perception in healthy people. Comparisons between lung injury patterns in COVID-19 and other causes of ARDS are clouded by the extent and severity of this pandemic, which may underlie the description of “new” phenotypes, although our ability to confirm these phenotypes by more invasive and longitudinal studies is limited. However, given the uncertainty about anything unique in the pathophysiology of COVID-19 lung injury, there are no compelling pathophysiological reasons at present to support a therapeutic approach for these patients that is different from the proven standards of care in ARDS.

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Section: Lung Parenchyma Compliance and Hypoxemia In Covid-19 Lung Injurymentioning

confidence: 99%

The Pathophysiology and Dangers of Silent Hypoxemia in COVID-19 Lung Injury

2021

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“…The standard of ARDS management is the use of lung-protective strategies that combine low tidal volume and relatively high PEEP [14]. However, high levels of PEEP may lead to lung overdistension associated with an increase of alveolar dead space [15].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Barotrauma in COVID-19 Patients Under Non-invasive Ventilation Support: Case Series

Decker¹

2022

AJBSR

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“…The pathophysiology of COVID-19 is still matter of investigation, but it has been suggested that at least in a subset of patients this form of lung injury is not similar to those with ARDS unrelated to COVID-19 [32,33,34]. Ramin et al [35] demonstrated in the early stage (median time between admission and intubation was 2 days), a static lung elastance of 19 cmH2O/l and a low ΔPL (4 cmH2O) on day 1 of invasive mechanical ventilation. It has been shown that the lung weight in moderate and severe spontaneous breathing COVID-19 patients treated with helmet CPAP or NIV was approximately half of what has been described in typical ARDS with similar severity, confirming the dissociation between the gas exchange and the anatomical lung characteristics, typical of Covid-19 patients at early stage of disease [18].…”

Section: ]mentioning

confidence: 99%