ArticleBMJ open respiratory research2026
Shunt estimation in pneumonia of different aetiologies: a non-invasive physiological assessment.
Article in BMJ open respiratory research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionCOVID-19 has challenged traditional models of respiratory failure, and several studies have suggested that gas exchange impairment in COVID-19 pneumonia may involve mechanisms beyond anatomical shunt. This has renewed interest in non-invasive physiological tools to explore gas exchange abnormalities, including the evaluation of shunt, dead space and ventilation/perfusion mismatch. MATERIAL AND
methodsThis prospective cross-sectional study was conducted between October 2020 and January 2021 at Papa Giovanni XXIII Hospital (Bergamo, Italy), enrolling adults with acute respiratory failure due to COVID-19 or other pneumonias. Pulmonary shunt fraction was estimated non-invasively via the BEACON system using peripheral oxigen saturation (SpO₂)/fraction of inspired oxygen responses during incremental oxygen steps. Chest CT scans were quantitatively analysed for pathological patterns. The primary outcome was the comparison of BEACON-estimated shunt fraction between COVID-19 and non-COVID-19 groups; the secondary outcome included correlations with CT findings.
resultsA total of 51 patients were enrolled, including 36 with COVID-19 and 15 with non-COVID-19 pneumonia. COVID-19 patients showed significantly higher pulmonary shunt fractions (18.2% vs 12.5%, p=0.022). In non-COVID-19 cases, shunt fraction correlated positively with the extent of CT consolidations (ρ=0.567, p=0.035) and negatively with ground-glass opacities (ρ =-0.565, p=0.035). No significant correlations between shunt and CT findings were observed in COVID-19 patients.
conclusionsOur findings demonstrate increased estimated shunt in COVID-19 pneumonia despite comparable radiological severity to non-COVID-19 pneumonias, reinforcing the concept of distinct gas exchange pathophysiology across different pneumonia aetiologies.
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