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Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia

Early stages of the novel coronavirus disease (COVID-19) are associated with silent hypoxia and poor oxygenation despite relatively minor parenchymal involvement. Although speculated that such paradoxical findings may be explained by impaired hypoxic pulmonary vasoconstriction in infected lung regio...

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Autores principales: Herrmann, Jacob, Mori, Vitor, Bates, Jason H. T., Suki, Béla
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522238/
https://www.ncbi.nlm.nih.gov/pubmed/32985528
http://dx.doi.org/10.1038/s41467-020-18672-6
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author Herrmann, Jacob
Mori, Vitor
Bates, Jason H. T.
Suki, Béla
author_facet Herrmann, Jacob
Mori, Vitor
Bates, Jason H. T.
Suki, Béla
author_sort Herrmann, Jacob
collection PubMed
description Early stages of the novel coronavirus disease (COVID-19) are associated with silent hypoxia and poor oxygenation despite relatively minor parenchymal involvement. Although speculated that such paradoxical findings may be explained by impaired hypoxic pulmonary vasoconstriction in infected lung regions, no studies have determined whether such extreme degrees of perfusion redistribution are physiologically plausible, and increasing attention is directed towards thrombotic microembolism as the underlying cause of hypoxemia. Herein, a mathematical model demonstrates that the large amount of pulmonary venous admixture observed in patients with early COVID-19 can be reasonably explained by a combination of pulmonary embolism, ventilation-perfusion mismatching in the noninjured lung, and normal perfusion of the relatively small fraction of injured lung. Although underlying perfusion heterogeneity exacerbates existing shunt and ventilation-perfusion mismatch in the model, the reported hypoxemia severity in early COVID-19 patients is not replicated without either extensive perfusion defects, severe ventilation-perfusion mismatch, or hyperperfusion of nonoxygenated regions.
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spelling pubmed-75222382020-10-19 Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia Herrmann, Jacob Mori, Vitor Bates, Jason H. T. Suki, Béla Nat Commun Article Early stages of the novel coronavirus disease (COVID-19) are associated with silent hypoxia and poor oxygenation despite relatively minor parenchymal involvement. Although speculated that such paradoxical findings may be explained by impaired hypoxic pulmonary vasoconstriction in infected lung regions, no studies have determined whether such extreme degrees of perfusion redistribution are physiologically plausible, and increasing attention is directed towards thrombotic microembolism as the underlying cause of hypoxemia. Herein, a mathematical model demonstrates that the large amount of pulmonary venous admixture observed in patients with early COVID-19 can be reasonably explained by a combination of pulmonary embolism, ventilation-perfusion mismatching in the noninjured lung, and normal perfusion of the relatively small fraction of injured lung. Although underlying perfusion heterogeneity exacerbates existing shunt and ventilation-perfusion mismatch in the model, the reported hypoxemia severity in early COVID-19 patients is not replicated without either extensive perfusion defects, severe ventilation-perfusion mismatch, or hyperperfusion of nonoxygenated regions. Nature Publishing Group UK 2020-09-28 /pmc/articles/PMC7522238/ /pubmed/32985528 http://dx.doi.org/10.1038/s41467-020-18672-6 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Herrmann, Jacob
Mori, Vitor
Bates, Jason H. T.
Suki, Béla
Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia
title Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia
title_full Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia
title_fullStr Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia
title_full_unstemmed Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia
title_short Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia
title_sort modeling lung perfusion abnormalities to explain early covid-19 hypoxemia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522238/
https://www.ncbi.nlm.nih.gov/pubmed/32985528
http://dx.doi.org/10.1038/s41467-020-18672-6
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