Explaining ARDS and how covid-19 attacks the lungs

Channel: Washington Post
Published: 08/03/2020

Description
Ajeet Vinayak of Georgetown University Hospital breaks down how the covid-19 virus attacks the lungs of patients, leaving possible long lasting damage. Read more: https://wapo.st/2PnQXc8. Subscribe to The Washington Post on YouTube: https://wapo.st/2QOdcqK Follow us: Twitter: https://twitter.com/w



Transcript
Acute respiratory distress syndrome or ards is a life-threatening lung injury that results in dangerously low levels of oxygen in the blood, also known as hypoxemia ards has been a known symptom of pneumonia influenza and now coven 19. , when cobit first started the paradigm that we have become So used to treating severe infection related hypoxemia was ards in ards. The impairment often is um in t ...
e alveoli or in the interstitium or the spongy part of the lung. Alveoli are those small air sacs that gas exchange occurs across both oxygen, going onto the blood and carbon dioxide getting offloaded for us to breathe out, and if it's significant enough, then gas. That oxygen in particular is difficult to diffuse across airways alveoli interstitium to the blood vessels. This leads to low levels of blood oxygen or hypoxemia that can have severe impact on multiple organs throughout the body. The extent of the damage caused by ards in covin-19 patients can most effectively be seen when comparing x-rays and ct scans of their lungs. The areas that the lung are the represented by the darker areas, because that's air-filled spaces that show up black on the chest x-ray. In the center there you see the heart opacified in white, in the middle, but around it should be surrounded by dark lung tissue, and you can see that in the edges of the lung, in particular on the right side of the image in the middle of the Lung field, there's extra areas of white and those areas are due to injury and scarring within the air spaces within the alveoli on the cat scan we'll see similar findings. The heart should be the in the center and is that wider, more pacified area and it should be surrounded by dark gray, material, dark gray to dark material, which is the lung. This ct scan cat scan of the lung is significantly abnormal, because there is diffuse abnormalities. You can see dense consolidations that you don't necessarily make dark air spaces evident through them.

Covid19 ards is unique in that it can also damage the patient's blood vessels, while promoting significant blood clotting. We ourselves, when examining patients using ultrasound modalities and cat scans, found a good number of clot, either traveling through the heart on the way to the lungs or within the lungs. Not only is the alveolar surface and the spongy interstitial part of the lung damaged by the infection, but now there is an impairment. On the other side, the blood vessels, both direct injury to the blood vessels and clot within the blood vessels. This one-two punch of ards and clotting multiplies the likelihood of severe hypoxemia, while also leading to possible organ failure or the patient suffering a stroke. The chronicity of this is unknown for those patients that come into the hospital with significant enough covid, and especially for those patients that come into the icu and need a ventilator. It is very likely that they may have more permanent damage. What we do know is based on the experience with sarsko v1, the initial star syndrome and those patients that have severe influenza syndrome, such as the avian flu from years past that when people have looked at those patients that have come through the icu and or been On the ventilator that many of them, if not the majority of them, will have abnormalities that you can still pick up on imaging, be it chest x-ray or cat scan. The other scary issue with this novel virus is the potential that, beyond the lung, there may be impact to other organs. That'S long, lasting in particular skin soft tissue and nerves and brain, and we just don't know the full impact down the road.


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