Intrapulmonary shunt and alveolar dead space in a cohort of patients with acute COVID-19 pneumonitis and early recovery.
| Autor: | Harbut P; Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden., Prisk GK; Department of Medicine, University of California, San Diego, CA, USA., Lindwall R; Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden., Hamzei S; Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden., Palmgren J; Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden., Farrow CE; Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Sydney, Australia.; Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, Australia.; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia., Hedenstierna G; Department of Medical Sciences, University of Uppsala, Uppsala, Sweden.; Deceased., Amis TC; Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Sydney, Australia.; Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, Australia.; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia., Malhotra A; Department of Medicine, University of California, San Diego, CA, USA., Wagner PD; Department of Medicine, University of California, San Diego, CA, USA., Kairaitis K; Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Sydney, Australia kristina.kairaitis@sydney.edu.au.; Department of Respiratory and Sleep Medicine, Westmead Hospital, Sydney, Australia.; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. |
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| Jazyk: | angličtina |
| Zdroj: | The European respiratory journal [Eur Respir J] 2023 Jan 27; Vol. 61 (1). Date of Electronic Publication: 2023 Jan 27 (Print Publication: 2023). |
| DOI: | 10.1183/13993003.01117-2022 |
| Abstrakt: | Background: Pathological evidence suggests that coronavirus disease 2019 (COVID-19) pulmonary infection involves both alveolar damage (causing shunt) and diffuse microvascular thrombus formation (causing alveolar dead space). We propose that measuring respiratory gas exchange enables detection and quantification of these abnormalities. We aimed to measure shunt and alveolar dead space in moderate COVID-19 during acute illness and recovery. Methods: We studied 30 patients (22 males; mean±sd age 49.9±13.5 years) 3-15 days from symptom onset and again during recovery, 55±10 days later (n=17). Arterial blood (breathing ambient air) was collected while exhaled oxygen and carbon dioxide concentrations were measured, yielding alveolar-arterial differences for each gas ( P Results: For acute COVID-19 patients, group mean (range) for P Conclusions: We speculate impaired pulmonary gas exchange in early COVID-19 pneumonitis arises from two concurrent, independent and variable processes (alveolar filling and pulmonary vascular obstruction). For most patients these resolve within weeks; however, high alveolar dead space in ∼30% of recovered patients suggests persistent pulmonary vascular pathology. Competing Interests: Conflict of interest: A. Malhotra has received grants from the National Institutes of Health, and consulting fees for medical education from Livanova, Equilium, Corvus and Jazz. P.D. Wagner has received consulting fees from SMS Biotechnology and Third Pole Inc., and has participated on the data safety monitoring board on Dr Levine's (UT Southwestern, Dallas, TX, USA) PPG. P. Harbut received an unconditional loan of the equipment used in this study from the Djurgården Hockey Club, Stockholm. No other author has a conflict of interest to declare. (Copyright ©The authors 2023.) |
| Databáze: | MEDLINE |
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