ABSTRACT
Coronavirus disease-2019 (COVID-19) causes severe hypoxemia which fulfills the criteria of acute respiratory distress syndrome (ARDS) but is not accompanied by typical features of the syndrome. The combination of factors including low P/F ratios, high A-a gradient, relatively preserved lung mechanics, and normal pulmonary pressures may imply a process occurring on the vascular side of the alveolar-capillary unit. The scant but rapidly evolving data available on the pathophysiology are seemingly conflicting, indicating the relative dominance of intrapulmonary shunting or dead space in different studies. In this hypothesis paper, we attempt to gather and explain these observations within a unified conceptual framework by invoking the relative contributions of microvascular thrombosis, along with two proposed vascular mechanisms of capillary flow redistribution and flow through intrapulmonary arteriovenous anastomoses (IPAVA). How to cite this article: Nitsure M, Sarangi B, Shankar GH, Reddy VS, Walimbe A, Sharma V, et al. Mechanisms of Hypoxia in COVID-19 Patients: A Pathophysiologic Reflection. Indian J Crit Care Med 2020;24(10):967-970.
ABSTRACT
OBJECTIVE: To assess the epidemiological and clinical characteristics of pediatric inpatients with COVID-19, early in the pandemic. METHODS: Clinical and laboratory profile and outcomes were studied for children (aged 1 month - 18 years) presenting between 1 April, 2020 and 20 May, 2020 with positive nasopharyngeal swab for SARS-CoV-2 by RT-PCR. RESULTS: 50 children (56% male) with median (IQR) age of 6 (2-12) years were included. Majority (56%) were from families belonging to Kuppuswamy upper lower socioeconomic class. 45 (90%) had positive household contact, and 33 (66%) had overcrowding at home. 29 (58%) children were asymptomatic while 20 (40%) had mild symptoms. Fever, cough, and sore throat were the most common symptoms. High C-reactive protein levels were seen in 15 (30%) children. There was no mortality. CONCLUSION: The disease burden appears high in lower socio-economic group with majority having a positive household contact. Milder disease pattern in the pediatric age group is reiterated.