Back to Search
Start Over
Functional pathophysiology of SARS-CoV-2-induced acute lung injury and clinical implications
- Source :
- Journal of Applied Physiology
- Publication Year :
- 2021
- Publisher :
- American Physiological Society, 2021.
-
Abstract
- The worldwide pandemic caused by the SARS-CoV-2 virus has resulted in over 84,407,000 cases, with over 1,800,000 deaths when this paper was submitted, with comorbidities such as gender, race, age, body mass, diabetes, and hypertension greatly exacerbating mortality. This review will analyze the rapidly increasing knowledge of COVID-19-induced lung pathophysiology. Although controversial, the acute respiratory distress syndrome (ARDS) associated with COVID-19 (CARDS) seems to present as two distinct phenotypes: type L and type H. The “L” refers to low elastance, ventilation/perfusion ratio, lung weight, and recruitability, and the “H” refers to high pulmonary elastance, shunt, edema, and recruitability. However, the LUNG-SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) and ESICM (European Society of Intensive Care Medicine) Trials Groups have shown that ∼13% of the mechanically ventilated non-COVID-19 ARDS patients have the type-L phenotype. Other studies have shown that CARDS and ARDS respiratory mechanics overlap and that standard ventilation strategies apply to these patients. The mechanisms causing alterations in pulmonary perfusion could be caused by some combination of 1) renin-angiotensin system dysregulation, 2) thrombosis caused by loss of endothelial barrier, 3) endothelial dysfunction causing loss of hypoxic pulmonary vasoconstriction perfusion control, and 4) hyperperfusion of collapsed lung tissue that has been directly measured and supported by a computational model. A flowchart has been constructed highlighting the need for personalized and adaptive ventilation strategies, such as the time-controlled adaptive ventilation method, to set and adjust the airway pressure release ventilation mode, which recently was shown to be effective at improving oxygenation and reducing inspiratory fraction of oxygen, vasopressors, and sedation in patients with COVID-19.
- Subjects :
- medicine.medical_specialty
ARDS
Physiology
Acute Lung Injury
Review
Respiratory physiology
Lung injury
Airway pressure release ventilation
03 medical and health sciences
0302 clinical medicine
TCAV
Physiology (medical)
Internal medicine
Hypoxic pulmonary vasoconstriction
medicine
Animals
Humans
Hypoxia
Lung
Respiratory Distress Syndrome
Continuous Positive Airway Pressure
SARS-CoV-2
business.industry
COVID-19
030208 emergency & critical care medicine
medicine.disease
medicine.anatomical_structure
030228 respiratory system
Vasoconstriction
Cardiology
Breathing
business
Perfusion
Subjects
Details
- ISSN :
- 15221601 and 87507587
- Volume :
- 130
- Database :
- OpenAIRE
- Journal :
- Journal of Applied Physiology
- Accession number :
- edsair.doi.dedup.....0eef6f232cb49098d7da2002db88093e