
The pathomechanism of “silent” severe hypoxemia leading to acute respiratory failure in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is not understood. This failed vasoregulation was associated with a severe intrapulmonary shunt, as assessed by the number of microbubbles via transcranial Doppler after injection of agitated saline in a central or peripheral venous catheter. A recent study using dual-energy computed tomography in a cohort of 35 patients with COVID-19 found perfusion disturbances characterized by the coexistence of intrapulmonary shunts, dead space, and high and low gas/blood ratios.
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