COVID‐19 critical illness pathophysiology driven by diffuse pulmonary thrombi and pulmonary endothelial dysfunction responsive to thrombolysis
Autor: | Glen Chun, Thomas M. Tolbert, Jeffrey W. Olin, Neha S. Dangayach, Corey E. Ventetuolo, Amanda Zeidman, Charles A. Powell, Hooman D. Poor, Roopa Kohli-Seth, Gregory Serrao |
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Rok vydání: | 2020 |
Předmět: |
0301 basic medicine
thrombolysis medicine.medical_specialty ARDS Short Communication medicine.medical_treatment Medicine (miscellaneous) macromolecular substances Article 03 medical and health sciences 0302 clinical medicine COVID‐19 Internal medicine medicine tPA Endothelial dysfunction lcsh:R5-920 tissue plasminogen activator Vascular disease business.industry Thrombolysis medicine.disease Pneumonia 030104 developmental biology nervous system Respiratory failure 030220 oncology & carcinogenesis Shock (circulatory) Breathing Cardiology Molecular Medicine medicine.symptom lcsh:Medicine (General) business |
Zdroj: | Clinical and Translational Medicine medRxiv article-version (status) pre article-version (number) 1 Clinical and Translational Medicine, Vol 10, Iss 2, Pp n/a-n/a (2020) |
ISSN: | 2001-1326 |
Popis: | Patients with severe COVID‐19 disease have been characterized as having the acute respiratory distress syndrome (ARDS). Critically ill COVID‐19 patients have relatively well‐preserved lung mechanics despite severe gas exchange abnormalities, a feature not consistent with classical ARDS but more consistent with pulmonary vascular disease. Many patients with severe COVID‐19 also demonstrate markedly abnormal coagulation, with elevated d‐dimers and higher rates of venous thromboembolism. We present four cases of patients with severe COVID‐19 pneumonia with severe respiratory failure and shock, with evidence of markedly elevated dead‐space ventilation who received tPA. All showed post treatment immediate improvements in gas exchange and/or hemodynamics. We suspect that severe COVID‐19 pneumonia causes respiratory failure via pulmonary microthrombi and endothelial dysfunction. Treatment for COVID‐19 pneumonia may warrant anticoagulation for milder cases and thrombolysis for more severe disease. |
Databáze: | OpenAIRE |
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