Reversible platypnea-orthodeoxia in COVID-19 acute respiratory distress syndrome survivors
| Autor: | Po Ying Chia, Barnaby Edward Young, Bingwen Eugene Fan, Geak Poh Tan, Cher Heng Tan, Sennen Jin Wen Lew, John A Abisheganaden, Sharlene Ho, Sanjay H. Chotirmall, Ser Hon Puah |
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| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty Supine position Physiology medicine.medical_treatment Pneumonia Viral Posture Respiratory physiology Article 03 medical and health sciences Basal (phylogenetics) Orthostatic vital signs Betacoronavirus 0302 clinical medicine Internal medicine medicine Humans Survivors Pandemics Aged Retrospective Studies Mechanical ventilation Respiratory Distress Syndrome business.industry SARS-CoV-2 General Neuroscience Rehabilitation COVID-19 Retrospective cohort study Pneumonia Middle Aged medicine.disease Shunting Coronavirus Critical care Dyspnea 030228 respiratory system Cardiology Female business Coronavirus Infections 030217 neurology & neurosurgery |
| Zdroj: | Respiratory Physiology & Neurobiology |
| ISSN: | 1878-1519 |
| Popis: | Highlights • Platypnea-orthodeoxia syndrome (POS) is observed in COVID-19 acute respiratory distress syndrome (ARDS) survivors. • POS is associated with older age, lower body mass index and varying degrees of dyspnea. • Arterial to end-tidal carbon dioxide and alveolar to arterial oxygen partial pressure differences were persistently elevated. • POS is likely a gravitational exacerbation of intrapulmonary shunt in ARDS due to COVID-19 specific changes. • POS may cause alarm and requires adjustment in the rehabilitation approach during the recovery period. Platypnea-orthodeoxia syndrome (POS) is a rare clinical syndrome characterized by orthostatic oxygen desaturation and positional dyspnea from supine to an upright position. We observed POS in 5 of 20 cases of severe 2019 novel coronavirus (COVID-19) pneumonia, which demonstrated persistently elevated shunt fraction even after liberation from mechanical ventilation. POS was first observed during physiotherapy sessions; median oxygen desaturation was 8 % (range: 8–12 %). Affected individuals were older (median 64 vs 53 years old, p = 0.05) and had lower body mass index (median 24.7 vs 27.6 kg/m2, p = 0.03) compared to those without POS. While POS caused alarm and reduced tolerance to therapy, this phenomenon resolved over a median of 17 days with improvement of parenchymal disease. The mechanisms of POS are likely due to gravitational redistribution of pulmonary blood flow resulting in increased basal physiological shunting and upper zone dead space ventilation due to the predominantly basal distribution of consolidative change and reported vasculoplegia and microthrombi in severe COVID-19 disease. |
| Databáze: | OpenAIRE |
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