Naseer Al Busaidi
Department of Pulmonology, Respiratory Unit, Royal Hospital, Muscat, OmanFulltext PDF
The lungs are the most affected organ due to SARS-CoV-2 infection. The lung damage due to severe COVID-19 is not similar to traditional ARDS. The histological analysis displayed Diffuse Alveolar Damage (DAD) with cellular fibro-myxoid exudates, desquamation of pneumocytes, pulmonary edema and hyaline membrane formation, which is similar histopathological changes seen in Acute Respiratory Distress Syndrome (ARDS). Patients with COVID-19 related lung injury fullfill the Berlin criteria of ARDS (i.e. PaO2/FiO2 ratio ≤ 200, measured at PEEP=5 cmH2O) could present with certain characteristics, as compared to classical forms of ARDS. Such as refractory hypoxemia which doesn’t correlate with relatively preserved lung mechanics, hypercapnia with high Ventilatory Ratio (VR) and also low alveolar recruitability which is improved by body positioning. The pathophysiology of COVID-19 related ARDS is different from ARDS induced by other causes; COVID-19 patients usually present with an intense endothelial dysfunction and thrombo-inflammatory state which leads to both micro-thrombosis and macro-thrombosis along with extreme pulmonary vasoconstriction which leads to significant alveolar dead space
COVID-19; Acute respiratory distress syndrome; Diffuse alveolar damage; Elastance; Recruitability;Covid-19; Covid; Corona Virus; Coronavirus disease 2019
Al Busaidi N. COVID-19-Induced Acute Respiratory Distress Syndrome (CARDS) Management. Int J Fam Med Prim Care. 2021; 2(4): 1044.