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Identifying putative ventilation-perfusion distributions in COVID-19 pneumonia
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Identifying putative ventilation-perfusion distributions in COVID-19 pneumonia
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Journal Article
Identifying putative ventilation-perfusion distributions in COVID-19 pneumonia
2022
Overview
Busana et al . ( doi.org/10.1152/japplphysiol.00871.2020 ) published 5 patients with COVID-19 in whom the fraction of non-aerated lung tissue had been quantified by computed tomography. They assumed that shunt flow fraction was proportional to the non-aerated lung fraction, and, by randomly generating 10 6 different bimodal distributions for the ventilation-perfusion ( V ˙ / Q ˙ ) ratios in the lung, specified as sets of paired values V ˙ i , Q ˙ i , sought to identify as solutions those that generated the observed arterial partial pressures of CO 2 and O 2 (Pa CO2 and Pa O2 ). Our study sought to develop a direct method of calculation to replace the approach of randomly generating different distributions, and so provide more accurate solutions that were within the measurement error of the blood-gas data. For the one patient in whom Busana et al . did not find solutions, we demonstrated that the assumed shunt flow fraction led to a non-shunt blood flow that was too low to support the required gas exchange. For the other four patients, we found precise solutions (prediction error < 1x10 -3 mmHg for both Pa CO2 and Pa O2 ), with distributions qualitatively similar to those of Busana et al . These distributions were extremely wide and unlikely to be physically realisable, because they predict the maintenance of very large concentration gradients in regions of the lung where convection is slow. We consider that these wide distributions arise because the assumed value for shunt flow is too low in these patients, and we discuss possible reasons why the assumption relating to shunt flow fraction may break down in COVID-19 pneumonia.
Publisher
Public Library of Science,Public Library of Science (PLoS)
Subject
/ Aeration
/ Blood
/ Complications and side effects
/ COVID-19
/ Flow
/ Lungs
/ Medicine and Health Sciences
/ Patients
/ Ratios
/ Shunts
