Early identification of these physiologic and clinical biomarkers could trigger the institution of therapies aiming to reverse the hypercoagulable state and support right ventricular function.īlood coagulation disorder coronavirus disease 2019 hypercapnia hypoxemia respiratory dead space respiratory failure.Ĭopyright © 2020 The Authors. We speculate that thromboinflammation with pulmonary microvasculature occlusion leads to a sudden increase in dead space and shunt resulting in severe hypercapnia and hypoxemia in coronavirus disease 2019 patients. Marked improvement in Pao 2 allowed reduction in Fio 2 in all patients, extracorporeal Co 2 removal was discontinued in three patients over the ensuing 3 weeks, and one patient was discharged home. Management included extracorporeal Co 2 removal, direct thrombin inhibition, pulmonary vasodilators, and inotropic support. ![]() There was sequential development of: 1) severe hypercapnia attributable to marked elevation of dead space without radiographic changes 2) concomitant coagulopathy manifest by an increase in d-dimer levels 3) progressive shunt with consequent hypoxemia and 4) right ventricular dysfunction. The pillars of management were targeted to improve pulmonary vascular patency via aggressive anticoagulation and support right ventricular function.įour consecutive patients with confirmed coronavirus disease 2019 infection with sudden hypercapnia and hypoxemia were included. Hypercapnia could not be explained by worsening lung disease or other common factors, and thus, a pulmonary vascular etiology was suggested. ![]() This case series highlights clinical findings and management of coronavirus disease 2019 patients with refractory hypercapnia despite maximal/optimal ventilatory support. Some patients develop sudden refractory hypercapnia and hypoxemia not explained by worsening pulmonary parenchymal disease. ![]() Mortality rates in intubated coronavirus disease 2019 patients remain markedly elevated.
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