Advertisement
Mayo Clinic Proceedings Home

Progressive Hypoxia

A Pivotal Pathophysiologic Mechanism of COVID-19 Pneumonia
Published:September 29, 2020DOI:https://doi.org/10.1016/j.mayocp.2020.09.015
      Coronavirus disease 2019 (COVID-19) infection has been linked to a broad range of organ involvement including lungs, heart and blood vessels, and gastrointestinal tract.
      • Wadman M.
      • Couzin-Frankel J.
      • Kaiser J.
      • Matacic C.
      How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes. 2020. Science.
      The most common presentation has been of viral pneumonia, characterized by progressive hypoxia, often in the absence of appropriate shortness of breath. On the other hand, dyspnea and low oxygen saturation are markers of poor prognosis.
      • Xie J.
      • Covassin N.
      • Fan Z.
      • et al.
      Association between hypoxemia and mortality in patients with COVID-19.
      Thresholds for oxygen supplementation vary widely. Given the overlap between pathophysiologic effects of hypoxia and pathophysiology of COVID-19, we propose that progressive hypoxia may act as an amplifier of the COVID-19 disease process, which may conceivably be interrupted by aggressive, early, and effective oxygen supplementation.

      Abbreviations and Acronyms:

      COVID-19 (coronavirus disease 2019)
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Wadman M.
        • Couzin-Frankel J.
        • Kaiser J.
        • Matacic C.
        How does coronavirus kill? Clinicians trace a ferocious rampage through the body, from brain to toes. 2020. Science.
        • Xie J.
        • Covassin N.
        • Fan Z.
        • et al.
        Association between hypoxemia and mortality in patients with COVID-19.
        Mayo Clin Proc. 2020; 95: 1138-1147
        • Kashani K.B.
        Hypoxia in COVID-19: sign of severity or cause for poor outcomes.
        Mayo Clin Proc. 2020; 95: 1094-1096
        • Eltzschig H.K.
        • Carmeliet P.
        Hypoxia and inflammation.
        N Engl J Med. 2011; 364: 656-665
        • Vassilaki N.
        • Kalliampakou K.I.
        • Kotta-Loizou I.
        • et al.
        Low oxygen tension enhances hepatitis C virus replication.
        J Virol. 2013; 87: 2935-2948
        • López-Rodríguez D.M.
        • Kirillov V.
        • Krug L.T.
        • Mesri E.A.
        • Andreansky S.
        A role of hypoxia- inducible factor 1 alpha in Murine Gammaherpesvirus 68 (MHV68) lytic replication and reactivation from latency.
        PLoS Pathog. 2019; 15: e1008192
        • Sommer N.
        • Dietrich A.
        • Schermuly R.T.
        • et al.
        Regulation of hypoxic pulmonary vasoconstriction: basic mechanisms.
        Eur Resp J. 2008; 32: 1639-1651
        • Pilli V.S.
        • Datta A.
        • Afreen S.
        • Catalano D.
        • Szabo G.
        • Majumder R.
        Hypoxia downregulates protein S expression.
        Blood. 2018; 132: 452-455
        • Ferreyro B.L.
        • Angriman F.
        • Munshi L.
        • et al.
        Association of noninvasive oxygenation strategies with all-cause mortality in adults with acute hypoxemic respiratory failure A systematic review and meta-analysis.
        JAMA. 2020; 324: 57-67
        • Patel B.K.
        • Kress J.P.
        • Hall J.B.
        Alternatives to invasive ventilation in the COVID-19 pandemic.
        JAMA. 2020; 324: 43-44

      Linked Article