Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia

Jacob Herrmann; Vitor Mori; Jason H T Bates; Béla Suki

doi:10.1038/s41467-020-18672-6

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Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia

Journal article

Open access

Peer reviewed

Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia

Jacob Herrmann, Vitor Mori, Jason H T Bates and Béla Suki

Nature communications, Vol.11(1), pp.4883-4883

09/28/2020

DOI: 10.1038/s41467-020-18672-6

PMCID: PMC7522238

PMID: 32985528

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Abstract

Early stages of the novel coronavirus disease (COVID-19) are associated with silent hypoxia and poor oxygenation despite relatively minor parenchymal involvement. Although speculated that such paradoxical findings may be explained by impaired hypoxic pulmonary vasoconstriction in infected lung regions, no studies have determined whether such extreme degrees of perfusion redistribution are physiologically plausible, and increasing attention is directed towards thrombotic microembolism as the underlying cause of hypoxemia. Herein, a mathematical model demonstrates that the large amount of pulmonary venous admixture observed in patients with early COVID-19 can be reasonably explained by a combination of pulmonary embolism, ventilation-perfusion mismatching in the noninjured lung, and normal perfusion of the relatively small fraction of injured lung. Although underlying perfusion heterogeneity exacerbates existing shunt and ventilation-perfusion mismatch in the model, the reported hypoxemia severity in early COVID-19 patients is not replicated without either extensive perfusion defects, severe ventilation-perfusion mismatch, or hyperperfusion of nonoxygenated regions.

Betacoronavirus

Computer Simulation

Coronavirus Infections - complications

Coronavirus Infections - epidemiology

Coronavirus Infections - physiopathology

COVID-19

Humans

Hypoxia - etiology

Hypoxia - physiopathology

Hypoxia - therapy

Lung - blood supply

Lung - physiopathology

Lung Diseases - etiology

Lung Diseases - physiopathology

Lung Diseases - therapy

Mathematical Concepts

Models, Biological

Models, Cardiovascular

Oxygen Inhalation Therapy

Pandemics

Pneumonia, Viral - complications

Pneumonia, Viral - epidemiology

Pneumonia, Viral - physiopathology

Pulmonary Circulation - physiology

SARS-CoV-2

Time Factors

Vasoconstriction - physiology

Vasodilation - physiology

Ventilation-Perfusion Ratio - physiology

Details

Title: Subtitle: Modeling lung perfusion abnormalities to explain early COVID-19 hypoxemia
Creators: Jacob Herrmann - Boston University
Vitor Mori - University of Vermont
Jason H T Bates - University of Vermont
Béla Suki - Boston University
Resource Type: Journal article
Publication Details: Nature communications, Vol.11(1), pp.4883-4883
DOI: 10.1038/s41467-020-18672-6
PMID: 32985528
PMCID: PMC7522238
NLM abbreviation: Nat Commun
ISSN: 2041-1723
eISSN: 2041-1723
Grant note: DOI: 10.13039/100000050, name: U.S. Department of Health & Human Services | NIH | National Heart, Lung, and Blood Institute, award: U01-HL-139466, R01-HL-142702; name: U.S. Department of Health & Human Services | NIH | National Heart, Lung, and Blood Institute
Language: English
Date published: 09/28/2020
Academic Unit: Roy J. Carver Department of Biomedical Engineering
Record Identifier: 9984306747902771

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