ArticleAnnals of the American Thoracic Society2021
The Pathophysiology and Dangers of Silent Hypoxemia in COVID-19 Lung Injury.
Article in Annals of the American Thoracic Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 1 of them a synthesis that pooled it.
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Who cites it
34 citing papers in PubMed, 1 synthesis or guideline pooled it, 61 citations in OpenAlex.
- The normal distribution of the hypoxic ventilatory response and methodological impacts: a meta-analysis and computational investigation.The Journal of physiology · 2023Pooled it
- Trial
- Factors for success of awake prone positioning in patients with COVID-19-induced acute hypoxemic respiratory failure: analysis of a randomized controlled trial.Critical care (London, England) · 2022Trial
- Exploring the association between happy hypoxia and Coronavirus disease 2019 in the triage phase.Future science OA · 2025Article
- Prognostic value of novel indices combining Shock Index, Reverse Shock Index, age, and oxygen saturation for predicting mortality in COVID-19 patients in Iran at emergency department triage: a cross-sectional study.Acute and critical care · 2025Article
- Prehospital oxygen-therapy and mortality in patients treated by emergency medical services: a prospective, observational multicenter study.World journal of emergency medicine · 2025Article
- Advances in gas-exchange physiology and pathophysiology.ERS monograph · 2025Article
- Happy Hypoxia With SARS-CoV-2 Pneumonitis: A Life-Threatening Case of a Medical Doctor.Cureus · 2025Article
- Modulation of the Oxygenation State and Intracellular pH of Erythrocytes by Inositol-Trispyrophosphate Investigated byJournal of cellular and molecular medicine · 2025Article
- Signaling pathways of marine-derived natural products on lung injury: from theFrontiers in pharmacology · 2025Review
- Infection to hypertension: a review of post-COVID-19 new-onset hypertension prevalence and potential underlying mechanisms.Frontiers in cardiovascular medicine · 2025Review
- Coronary Implications of COVID-19.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2025Review
- Can serum interleukin 34 levels be used as an indicator for the prediction and prognosis of COVID-19?PloS one · 2024Article
- Stratification of COVID-19 Patients with Moderate-to-Severe Hypoxemic Respiratory Failure for Response to High-Flow Nasal Cannula: A Retrospective Observational Study.Medicina (Kaunas, Lithuania) · 2023Observational
- Increased intrapulmonary shunt and alveolar dead space post-COVID-19.Journal of applied physiology (Bethesda, Md. : 1985) · 2023Article
- Is COVID-19 different from other causes of acute respiratory distress syndrome?Journal of intensive medicine · 2023Review
- New and personalized ventilatory strategies in patients with COVID-19.Frontiers in medicine · 2023Review
- ARDS in the time of corona: context and perspective.American journal of physiology. Lung cellular and molecular physiology · 2022Article
- SARS-CoV-2 infection- induced growth factors play differential roles in COVID-19 pathogenesis.Life sciences · 2022Article
- Determinants of Increased Effort of Breathing in Non-Intubated Critical COVID-19 Patients.Medicina (Kaunas, Lithuania) · 2022Article
Corrections and comments
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Authors and funding
3 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The ongoing coronavirus disease (COVID-19) pandemic has been unprecedented on many levels, not least of which are the challenges in understanding the pathophysiology of these new critically ill patients. One widely reported phenomenon is that of a profoundly hypoxemic patient with minimal to no dyspnea out of proportion to the extent of radiographic abnormality and change in lung compliance. This apparently unique presentation, sometimes called "happy hypoxemia or hypoxia" but better described as "silent hypoxemia," has led to the speculation of underlying pathophysiological differences between COVID-19 lung injury and acute respiratory distress syndrome (ARDS) from other causes. We explore three proposed distinctive features of COVID-19 that likely bear on the genesis of silent hypoxemia, including differences in lung compliance, pulmonary vascular responses to hypoxia, and nervous system sensing and response to hypoxemia. In the context of known principles of respiratory physiology and neurobiology, we discuss whether these particular findings are due to direct viral effects or, equally plausible, are within the spectrum of typical ARDS pathophysiology and the wide range of hypoxic ventilatory and pulmonary vascular responses and dyspnea perception in healthy people. Comparisons between lung injury patterns in COVID-19 and other causes of ARDS are clouded by the extent and severity of this pandemic, which may underlie the description of "new" phenotypes, although our ability to confirm these phenotypes by more invasive and longitudinal studies is limited. However, given the uncertainty about anything unique in the pathophysiology of COVID-19 lung injury, there are no compelling pathophysiological reasons at present to support a therapeutic approach for these patients that is different from the proven standards of care in ARDS.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.