![]() ![]() ![]() Arrows indicate timing of interventions including institution of extracorporeal C o 2 removal (ECCOR), dobutamine, and argatroban. Trends for Pa co 2, dead space to tidal volume ratio (V d/V t), plasma d-dimer, and intrapulmonary shunt are shown for a representative patient during care in the ICU. Accordingly, management was targeted to improve pulmonary vascular patency via aggressive anticoagulation, enhance pulmonary vascular perfusion, and support right ventricular (RV) function. Hypercapnia and hypoxemia were not explainable by worsening lung disease since radiographs were stable therefore, a progressive pulmonary microvascular occlusive process was suspected. We describe treatment of four consecutive patients that exhibited an unexpected severe hypercapnia and hypoxemia unresponsive to traditional ventilatory adjustments. Many COVID-19 patients develop significant hypoxemia not readily explained by the extent of radiographic infiltrates, shedding doubt on the notion that patients fail mechanical ventilation solely due to progressive COVID-19 related pneumonia and/or acute respiratory distress syndrome (ARDS) ( 2) an additional role of pulmonary vascular dysfunction was suggested and the term COVID-19 ARDS was coined ( 3). However, mortality rates in intubated patients remain markedly elevated ( 1). Since the commencement of the coronavirus disease 2019 (COVID-19) pandemic, ventilatory management has been a main focus of treatment. ![]()
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