Difficulties have risen while managing Acute Respiratory Distress Syndrome (ARDS) caused by COVID-19, although it meets the Berlin definition. Severe hypoxemia with near-normal compliance was noted along with coagulopathy. Understanding the precise pathophysiology of this atypical ARDS will assist researchers and physicians in improving their therapeutic approach. Previous work is limited to postmortem studies, while our report addresses patients under protective lung mechanical ventilation. An open-lung minithoracotomy was performed in 3 patients who developed ARDS related to COVID-19 and were admitted to the intensive care unit to carry out a pathological and microbiological analysis on lung tissue biopsy. Diffused alveolar damage with hyaline membranes was found, as well as plurifocal fibrin microthrombi and vascular congestion in all patients’ specimens. Microbiological cultures were negative, whereas qualitative Reversed Transcriptase Polymerase Chain Reaction (RT-PCR) detected SARS-CoV-2 in the pulmonary parenchyma and pleural fluid in two patients. COVID-19 causes progressive ARDS with onset of severe hypoxemia, underlying a dual mechanism: shunt effect through diffused alveolar damage and dead space effect through thrombotic injuries in microvascular beds. It seems reasonable to manage this ventilation-perfusion ratio mismatch using a high dose of anticoagulant combined with glucocorticoids.
【초록키워드】 COVID-19, SARS-CoV-2, Respiratory distress syndrome, Glucocorticoids, ARDS, High dose, intensive care, acute respiratory distress syndrome, mechanical ventilation, intensive care unit, lung, RT-PCR, Coagulopathy, polymerase chain reaction, Culture, pathophysiology, Hypoxemia, Patient, Compliance, understanding, respiratory, Berlin, specimens, patients, Dead space, Protective, Anticoagulant, Therapeutic approach, Analysis, Injury, Atypical, Shunt, pleural fluid, microthrombi, dual, respiratory distress, Chain Reaction, alveolar damage, hyaline membranes, shunt effect, tissue biopsy, hyaline membrane, reaction, chain, two patients, difficulty, thrombotic, lung tissue, severe hypoxemia, FIBRIN, physician, dead, pulmonary parenchyma, vascular congestion, researcher, Ventilation-perfusion ratio, caused, was performed, cause, assist, meet, 【제목키워드】 COVID-19, biopsy,