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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...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2020
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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. |
format | Online Article Text |
id | pubmed-7522238 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
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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