Article ; Online: Pathomechanisms Underlying Hypoxemia in Two COVID-19-Associated Acute Respiratory Distress Syndrome Phenotypes: Insights From Thrombosis and Hemostasis.
2021 Volume 57, Issue 1, Page(s) 1–6
Abstract: Background: The pathomechanisms of hypoxemia and treatment strategies for type H and type L acute ... leading to hypoxemia due to impaired blood flow and a high ventilation/perfusion (VA/Q) ratio. COVID-19 ... respiratory distress syndrome (ARDS) in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced ...
| Abstract | Background: The pathomechanisms of hypoxemia and treatment strategies for type H and type L acute respiratory distress syndrome (ARDS) in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) have not been elucidated. Main text: SARS-CoV-2 mainly targets the lungs and blood, leading to ARDS, and systemic thrombosis or bleeding. Angiotensin II-induced coagulopathy, SARS-CoV-2-induced hyperfibrin(ogen)olysis, and pulmonary and/or disseminated intravascular coagulation due to immunothrombosis contribute to COVID-19-associated coagulopathy. Type H ARDS is associated with hypoxemia due to diffuse alveolar damage-induced high right-to-left shunts. Immunothrombosis occurs at the site of infection due to innate immune inflammatory and coagulofibrinolytic responses to SARS-CoV-2, resulting in microvascular occlusion with hypoperfusion of the lungs. Lung immunothrombosis in type L ARDS results from neutrophil extracellular traps containing platelets and fibrin in the lung microvasculature, leading to hypoxemia due to impaired blood flow and a high ventilation/perfusion (VA/Q) ratio. COVID-19-associated ARDS is more vascular centric than the other types of ARDS. D-dimer levels have been monitored for the progression of microvascular thrombosis in COVID-19 patients. Early anticoagulation therapy in critical patients with high D-dimer levels may improve prognosis, including the prevention and/or alleviation of ARDS. Conclusions: Right-to-left shunts and high VA/Q ratios caused by lung microvascular thrombosis contribute to hypoxemia in type H and L ARDS, respectively. D-dimer monitoring-based anticoagulation therapy may prevent the progression to and/or worsening of ARDS in COVID-19 patients. |
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| MeSH term(s) | Anticoagulants/therapeutic use ; Biomarkers/blood ; Blood Platelets/metabolism ; COVID-19/physiopathology ; Extracellular Traps/metabolism ; Fibrin/metabolism ; Fibrin Fibrinogen Degradation Products/analysis ; Fibrinolysis ; Hemostasis/physiology ; Humans ; Hypoxia/physiopathology ; Lung/blood supply ; Microvessels/physiopathology ; Phenotype ; Respiratory Distress Syndrome/drug therapy ; Respiratory Distress Syndrome/physiopathology ; SARS-CoV-2 ; Thromboinflammation/physiopathology ; Thrombosis/drug therapy ; Thrombosis/physiopathology ; COVID-19 Drug Treatment | |||||
| Chemical Substances | Anticoagulants ; Biomarkers ; Fibrin Fibrinogen Degradation Products ; fibrin fragment D ; Fibrin (9001-31-4) | |||||
| Language | English | |||||
| Publishing date | 2021-06-29 | |||||
| Publishing country | United States | |||||
| Document type | Journal Article ; Research Support, Non-U.S. Gov't ; Review | |||||
| ZDB-ID | 1185432-7 | |||||
| ISSN | 1540-0514 ; 1073-2322 | |||||
| ISSN (online) | 1540-0514 | |||||
| ISSN | 1073-2322 | |||||
| DOI | 10.1097/SHK.0000000000001825 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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