Why COVID-19 Silent Hypoxemia Is Baffling to Physicians
Patients with coronavirus disease (COVID-19) are described as exhibiting oxygen levels incompatible with life without dyspnea. The pairing-dubbed happy hypoxia but more precisely termed silent hypoxemia-is especially bewildering to physicians and is considered as defying basic biology. This combinat...
Gespeichert in:
Veröffentlicht in: | American journal of respiratory and critical care medicine 2020-08, Vol.202 (3), p.356-360 |
---|---|
Hauptverfasser: | , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 360 |
---|---|
container_issue | 3 |
container_start_page | 356 |
container_title | American journal of respiratory and critical care medicine |
container_volume | 202 |
creator | Tobin, Martin J Laghi, Franco Jubran, Amal |
description | Patients with coronavirus disease (COVID-19) are described as exhibiting oxygen levels incompatible with life without dyspnea. The pairing-dubbed happy hypoxia but more precisely termed silent hypoxemia-is especially bewildering to physicians and is considered as defying basic biology. This combination has attracted extensive coverage in media but has not been discussed in medical journals. It is possible that coronavirus has an idiosyncratic action on receptors involved in chemosensitivity to oxygen, but well-established pathophysiological mechanisms can account for most, if not all, cases of silent hypoxemia. These mechanisms include the way dyspnea and the respiratory centers respond to low levels of oxygen, the way the prevailing carbon dioxide tension (Pa
) blunts the brain's response to hypoxia, effects of disease and age on control of breathing, inaccuracy of pulse oximetry at low oxygen saturations, and temperature-induced shifts in the oxygen dissociation curve. Without knowledge of these mechanisms, physicians caring for patients with hypoxemia free of dyspnea are operating in the dark, placing vulnerable patients with COVID-19 at considerable risk. In conclusion, features of COVID-19 that physicians find baffling become less strange when viewed in light of long-established principles of respiratory physiology; an understanding of these mechanisms will enhance patient care if the much-anticipated second wave emerges. |
doi_str_mv | 10.1164/rccm.202006-2157CP |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7397783</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2430686101</sourcerecordid><originalsourceid>FETCH-LOGICAL-p294t-3acd408b177f1fa59b196e9c51ca811efc611ab54072ba053583e6ce46a8bc1b3</originalsourceid><addsrcrecordid>eNpdkMtKw0AUhgdRbK2-gAsJuHGTOmcumcxG0HhpQWjB6y5MppN2Sm5mUjFv74BV1NU5cD5-vvMjdAx4DBCx81brckwwwTgKCXCRzHfQEDjlIZMC7_odCxoyJl8H6MC5NcZAYsD7aEAJp5JTMUTiZdUHyex5eh2CDB5sYaoumPRN_WFKq4KpC65Unhe2WgZdHcxXvbPaqsodor1cFc4cbecIPd3ePCaT8H52N00u78OGSNaFVOkFw3EGQuSQKy4zkJGRmoNWMYDJdQSgMs6wIJnC3j2mJtKGRSrONGR0hC6-cptNVpqF9nqtKtKmtaVq-7RWNv17qewqXdbvqaBSiJj6gLNtQFu_bYzr0tI6bYpCVabeuJQwoNJ3QaRHT_-h63rTVv49T1EcxRFg8NTJb6Mfle9O6SenInh6</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2430686101</pqid></control><display><type>article</type><title>Why COVID-19 Silent Hypoxemia Is Baffling to Physicians</title><source>MEDLINE</source><source>American Thoracic Society (ATS) Journals Online</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Tobin, Martin J ; Laghi, Franco ; Jubran, Amal</creator><creatorcontrib>Tobin, Martin J ; Laghi, Franco ; Jubran, Amal</creatorcontrib><description>Patients with coronavirus disease (COVID-19) are described as exhibiting oxygen levels incompatible with life without dyspnea. The pairing-dubbed happy hypoxia but more precisely termed silent hypoxemia-is especially bewildering to physicians and is considered as defying basic biology. This combination has attracted extensive coverage in media but has not been discussed in medical journals. It is possible that coronavirus has an idiosyncratic action on receptors involved in chemosensitivity to oxygen, but well-established pathophysiological mechanisms can account for most, if not all, cases of silent hypoxemia. These mechanisms include the way dyspnea and the respiratory centers respond to low levels of oxygen, the way the prevailing carbon dioxide tension (Pa
) blunts the brain's response to hypoxia, effects of disease and age on control of breathing, inaccuracy of pulse oximetry at low oxygen saturations, and temperature-induced shifts in the oxygen dissociation curve. Without knowledge of these mechanisms, physicians caring for patients with hypoxemia free of dyspnea are operating in the dark, placing vulnerable patients with COVID-19 at considerable risk. In conclusion, features of COVID-19 that physicians find baffling become less strange when viewed in light of long-established principles of respiratory physiology; an understanding of these mechanisms will enhance patient care if the much-anticipated second wave emerges.</description><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1164/rccm.202006-2157CP</identifier><identifier>PMID: 32539537</identifier><language>eng</language><publisher>United States: American Thoracic Society</publisher><subject>Betacoronavirus ; Coronavirus Infections - blood ; Coronavirus Infections - complications ; Coronavirus Infections - diagnosis ; COVID-19 ; Critical Care ; Dyspnea ; Dyspnea - blood ; Dyspnea - diagnosis ; Dyspnea - virology ; Health care ; Humans ; Hypoxia - blood ; Hypoxia - diagnosis ; Hypoxia - virology ; Male ; Middle Aged ; Oximetry ; Oxygen ; Oxygen - blood ; Pandemics ; Patient safety ; Physicians ; Pneumonia, Viral - blood ; Pneumonia, Viral - complications ; Pneumonia, Viral - diagnosis ; SARS-CoV-2</subject><ispartof>American journal of respiratory and critical care medicine, 2020-08, Vol.202 (3), p.356-360</ispartof><rights>Copyright American Thoracic Society Aug 1, 2020</rights><rights>Copyright © 2020 by the American Thoracic Society 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32539537$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tobin, Martin J</creatorcontrib><creatorcontrib>Laghi, Franco</creatorcontrib><creatorcontrib>Jubran, Amal</creatorcontrib><title>Why COVID-19 Silent Hypoxemia Is Baffling to Physicians</title><title>American journal of respiratory and critical care medicine</title><addtitle>Am J Respir Crit Care Med</addtitle><description>Patients with coronavirus disease (COVID-19) are described as exhibiting oxygen levels incompatible with life without dyspnea. The pairing-dubbed happy hypoxia but more precisely termed silent hypoxemia-is especially bewildering to physicians and is considered as defying basic biology. This combination has attracted extensive coverage in media but has not been discussed in medical journals. It is possible that coronavirus has an idiosyncratic action on receptors involved in chemosensitivity to oxygen, but well-established pathophysiological mechanisms can account for most, if not all, cases of silent hypoxemia. These mechanisms include the way dyspnea and the respiratory centers respond to low levels of oxygen, the way the prevailing carbon dioxide tension (Pa
) blunts the brain's response to hypoxia, effects of disease and age on control of breathing, inaccuracy of pulse oximetry at low oxygen saturations, and temperature-induced shifts in the oxygen dissociation curve. Without knowledge of these mechanisms, physicians caring for patients with hypoxemia free of dyspnea are operating in the dark, placing vulnerable patients with COVID-19 at considerable risk. In conclusion, features of COVID-19 that physicians find baffling become less strange when viewed in light of long-established principles of respiratory physiology; an understanding of these mechanisms will enhance patient care if the much-anticipated second wave emerges.</description><subject>Betacoronavirus</subject><subject>Coronavirus Infections - blood</subject><subject>Coronavirus Infections - complications</subject><subject>Coronavirus Infections - diagnosis</subject><subject>COVID-19</subject><subject>Critical Care</subject><subject>Dyspnea</subject><subject>Dyspnea - blood</subject><subject>Dyspnea - diagnosis</subject><subject>Dyspnea - virology</subject><subject>Health care</subject><subject>Humans</subject><subject>Hypoxia - blood</subject><subject>Hypoxia - diagnosis</subject><subject>Hypoxia - virology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Oximetry</subject><subject>Oxygen</subject><subject>Oxygen - blood</subject><subject>Pandemics</subject><subject>Patient safety</subject><subject>Physicians</subject><subject>Pneumonia, Viral - blood</subject><subject>Pneumonia, Viral - complications</subject><subject>Pneumonia, Viral - diagnosis</subject><subject>SARS-CoV-2</subject><issn>1073-449X</issn><issn>1535-4970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkMtKw0AUhgdRbK2-gAsJuHGTOmcumcxG0HhpQWjB6y5MppN2Sm5mUjFv74BV1NU5cD5-vvMjdAx4DBCx81brckwwwTgKCXCRzHfQEDjlIZMC7_odCxoyJl8H6MC5NcZAYsD7aEAJp5JTMUTiZdUHyex5eh2CDB5sYaoumPRN_WFKq4KpC65Unhe2WgZdHcxXvbPaqsodor1cFc4cbecIPd3ePCaT8H52N00u78OGSNaFVOkFw3EGQuSQKy4zkJGRmoNWMYDJdQSgMs6wIJnC3j2mJtKGRSrONGR0hC6-cptNVpqF9nqtKtKmtaVq-7RWNv17qewqXdbvqaBSiJj6gLNtQFu_bYzr0tI6bYpCVabeuJQwoNJ3QaRHT_-h63rTVv49T1EcxRFg8NTJb6Mfle9O6SenInh6</recordid><startdate>20200801</startdate><enddate>20200801</enddate><creator>Tobin, Martin J</creator><creator>Laghi, Franco</creator><creator>Jubran, Amal</creator><general>American Thoracic Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200801</creationdate><title>Why COVID-19 Silent Hypoxemia Is Baffling to Physicians</title><author>Tobin, Martin J ; Laghi, Franco ; Jubran, Amal</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p294t-3acd408b177f1fa59b196e9c51ca811efc611ab54072ba053583e6ce46a8bc1b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Betacoronavirus</topic><topic>Coronavirus Infections - blood</topic><topic>Coronavirus Infections - complications</topic><topic>Coronavirus Infections - diagnosis</topic><topic>COVID-19</topic><topic>Critical Care</topic><topic>Dyspnea</topic><topic>Dyspnea - blood</topic><topic>Dyspnea - diagnosis</topic><topic>Dyspnea - virology</topic><topic>Health care</topic><topic>Humans</topic><topic>Hypoxia - blood</topic><topic>Hypoxia - diagnosis</topic><topic>Hypoxia - virology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Oximetry</topic><topic>Oxygen</topic><topic>Oxygen - blood</topic><topic>Pandemics</topic><topic>Patient safety</topic><topic>Physicians</topic><topic>Pneumonia, Viral - blood</topic><topic>Pneumonia, Viral - complications</topic><topic>Pneumonia, Viral - diagnosis</topic><topic>SARS-CoV-2</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tobin, Martin J</creatorcontrib><creatorcontrib>Laghi, Franco</creatorcontrib><creatorcontrib>Jubran, Amal</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of respiratory and critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tobin, Martin J</au><au>Laghi, Franco</au><au>Jubran, Amal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Why COVID-19 Silent Hypoxemia Is Baffling to Physicians</atitle><jtitle>American journal of respiratory and critical care medicine</jtitle><addtitle>Am J Respir Crit Care Med</addtitle><date>2020-08-01</date><risdate>2020</risdate><volume>202</volume><issue>3</issue><spage>356</spage><epage>360</epage><pages>356-360</pages><issn>1073-449X</issn><eissn>1535-4970</eissn><abstract>Patients with coronavirus disease (COVID-19) are described as exhibiting oxygen levels incompatible with life without dyspnea. The pairing-dubbed happy hypoxia but more precisely termed silent hypoxemia-is especially bewildering to physicians and is considered as defying basic biology. This combination has attracted extensive coverage in media but has not been discussed in medical journals. It is possible that coronavirus has an idiosyncratic action on receptors involved in chemosensitivity to oxygen, but well-established pathophysiological mechanisms can account for most, if not all, cases of silent hypoxemia. These mechanisms include the way dyspnea and the respiratory centers respond to low levels of oxygen, the way the prevailing carbon dioxide tension (Pa
) blunts the brain's response to hypoxia, effects of disease and age on control of breathing, inaccuracy of pulse oximetry at low oxygen saturations, and temperature-induced shifts in the oxygen dissociation curve. Without knowledge of these mechanisms, physicians caring for patients with hypoxemia free of dyspnea are operating in the dark, placing vulnerable patients with COVID-19 at considerable risk. In conclusion, features of COVID-19 that physicians find baffling become less strange when viewed in light of long-established principles of respiratory physiology; an understanding of these mechanisms will enhance patient care if the much-anticipated second wave emerges.</abstract><cop>United States</cop><pub>American Thoracic Society</pub><pmid>32539537</pmid><doi>10.1164/rccm.202006-2157CP</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 1073-449X |
ispartof | American journal of respiratory and critical care medicine, 2020-08, Vol.202 (3), p.356-360 |
issn | 1073-449X 1535-4970 |
language | eng |
recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7397783 |
source | MEDLINE; American Thoracic Society (ATS) Journals Online; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
subjects | Betacoronavirus Coronavirus Infections - blood Coronavirus Infections - complications Coronavirus Infections - diagnosis COVID-19 Critical Care Dyspnea Dyspnea - blood Dyspnea - diagnosis Dyspnea - virology Health care Humans Hypoxia - blood Hypoxia - diagnosis Hypoxia - virology Male Middle Aged Oximetry Oxygen Oxygen - blood Pandemics Patient safety Physicians Pneumonia, Viral - blood Pneumonia, Viral - complications Pneumonia, Viral - diagnosis SARS-CoV-2 |
title | Why COVID-19 Silent Hypoxemia Is Baffling to Physicians |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T16%3A06%3A36IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Why%20COVID-19%20Silent%20Hypoxemia%20Is%20Baffling%20to%20Physicians&rft.jtitle=American%20journal%20of%20respiratory%20and%20critical%20care%20medicine&rft.au=Tobin,%20Martin%20J&rft.date=2020-08-01&rft.volume=202&rft.issue=3&rft.spage=356&rft.epage=360&rft.pages=356-360&rft.issn=1073-449X&rft.eissn=1535-4970&rft_id=info:doi/10.1164/rccm.202006-2157CP&rft_dat=%3Cproquest_pubme%3E2430686101%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2430686101&rft_id=info:pmid/32539537&rfr_iscdi=true |