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Open Access 01-12-2020 | Dyspnea | Review

The pathophysiology of ‘happy’ hypoxemia in COVID-19

Authors: Sebastiaan Dhont, Eric Derom, Eva Van Braeckel, Pieter Depuydt, Bart N. Lambrecht

Published in: Respiratory Research | Issue 1/2020

Abstract

The novel coronavirus disease 2019 (COVID-19) pandemic is a global crisis, challenging healthcare systems worldwide. Many patients present with a remarkable disconnect in rest between profound hypoxemia yet without proportional signs of respiratory distress (i.e. happy hypoxemia) and rapid deterioration can occur. This particular clinical presentation in COVID-19 patients contrasts with the experience of physicians usually treating critically ill patients in respiratory failure and ensuring timely referral to the intensive care unit can, therefore, be challenging. A thorough understanding of the pathophysiological determinants of respiratory drive and hypoxemia may promote a more complete comprehension of a patient’s clinical presentation and management. Preserved oxygen saturation despite low partial pressure of oxygen in arterial blood samples occur, due to leftward shift of the oxyhemoglobin dissociation curve induced by hypoxemia-driven hyperventilation as well as possible direct viral interactions with hemoglobin. Ventilation-perfusion mismatch, ranging from shunts to alveolar dead space ventilation, is the central hallmark and offers various therapeutic targets.

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Title: The pathophysiology of ‘happy’ hypoxemia in COVID-19
Authors: Sebastiaan Dhont
Eric Derom
Eva Van Braeckel
Pieter Depuydt
Bart N. Lambrecht
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Dyspnea
SARS-CoV-2
Hypoxemia
Dyspnea
COVID-19
Published in: Respiratory Research / Issue 1/2020
Electronic ISSN: 1465-993X
DOI: https://doi.org/10.1186/s12931-020-01462-5

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