medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-282medsovet-7903Research ArticleCOVID-19Гипоксемия без одышки при COVID-19Hypoxemia without dyspnea in COVID-19https://orcid.org/0000-0002-7425-0091ФанД. В.FanD. V.

Фан Девид Викторович, аспирант кафедры пульмонологии Института клинической медицины им. Н.В. Склифосовского

119991, Москва, ул. Большая Пироговская, д. 2, стр. 4

Devid V. Fan, Postgraduate Student of the Department of Pulmonology of Institute of Clinical Medicine named after N.V. Sklifosovsk

2, Bldg. 4, Bolshaya Pirogovskaya St., Moscow, 119991

fan_d_v@staff.sechenov.ruhttps://orcid.org/0000-0002-9509-0867НеклюдоваГ. В.NekludovaG. V.

Неклюдова Галина Васильевна, доктор медицинских наук, профессор кафедры пульмонологии Института клинической медицины им. Н.В. Склифосовского

119991, Москва, ул. Большая Пироговская, д. 2, стр. 4

Galina V. Nekludova,  Dr. Sci. (Med.), Professor of the Department of Pulmonology of Institute of Clinical Medicine named after N.V. Sklifosovsky

2, Bldg. 4, Bolshaya Pirogovskaya St., Moscow, 119991

nekludova_g_v@staff.sechenov.ruhttps://orcid.org/0000-0002-4335-3987БерикхановЗ. Г.-М.BerikkhanovZ. G.-M.

Берикханов Зелимхан Гези-Махмаевич, кандидат медицинских наук, доцент кафедры госпитальной хирургии №2 Института клинической медицины им. Н.В. Склифосовского

119991, Москва, ул. Большая Пироговская, д. 2, стр. 4

Zelimkhan G.-M. Berikkhanov, Cand. Sci. (Med.), Associate Professor of the Department of Hospital Surgery No. 2 of Institute of Clinical Medicine named after N.V. Sklifosovsky

2, Bldg. 4, Bolshaya Pirogovskaya St., Moscow, 119991

berikkhanov_z_g@staff.sechenov.ruhttps://orcid.org/0000-0002-5999-2150АвдеевС. Н.AvdeevS. N.

Авдеев Сергей Николаевич, доктор медицинских наук, профессор, академик РАН, заведующий кафедрой пульмонологии Института клинической медицины им. Н.В. Склифосовского

119991, Москва, ул. Большая Пироговская, д. 2, стр. 4

Sergey N. Avdeev, Dr. Sci. (Med.), Professor, Acad. of the Russian Academy of Sciences, Head of the Department of Pulmonology of Institute of Clinical Medicine named after N.V. Sklifosovsky

2, Bldg. 4, Bolshaya Pirogovskaya St., Moscow, 119991

avdeev_s_n@staff.sechenov.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202318112023020172179Copyright © Фан Д.В., Неклюдова Г.В., Берикханов З.Г., Авдеев С.Н., 20232023Фан Д.В., Неклюдова Г.В., Берикханов З.Г., Авдеев С.Н.Fan D.V., Nekludova G.V., Berikkhanov Z.G., Avdeev S.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7903

У пациентов с COVID-19 одышка может не являться основным симптомом заболевания. Имеется множество сообщений о том, что часть больных с гипоксемией при COVID-19 не предъявляли жалобы на одышку. На сегодняшний день нет единого мнения о клинической значимости гипоксемии без одышки. Ряд исследований указывают, что пациенты с гипоксемией без одышки не защищены от развития неблагоприятного исхода COVID-19. Неясно, является ли гипоксемия с одышкой и без одышки двумя отдельными фенотипами COVID-19 или двумя фазами болезни. На данный момент нет единого мнения по терминологии данного состояния, его определению и механизмам формирования. До настоящего времени не установлено, ассоциирована ли гипоксемия без одышки с благоприятным исходом заболевания или нет. Остается нерешенным вопрос, улучшает ли отсутствие дыхательного ответа на гипоксию прогноз заболевания у таких пациентов. Осуществлен анализ представленных на текущий момент данных литературы о механизмах развития гипоксемии и связанных с ними проявлениях одышки при инфекции, вызванной вирусом SARS-CoV-2. «Немая гипоксемия» может наблюдаться как при начальных проявлениях дыхательной недостаточности, так и при выраженном прогрессировании заболевания. Клиническая значимость «немой гипоксемии» состоит в том, что снижение физиологических реакций и отсутствие одышки позволяют пациентам чувствовать себя нормально, таким образом, отрицая тяжесть своего состояния и маскируя истинную тяжесть течения болезни. Кроме того, у пожилых пациентов и пациентов с сахарным диабетом следует ожидать угнетение дыхательной функции в ответ на гипоксию и развитие «немой гипоксемии» с быстрой декомпенсацией. Следует пересмотреть свое отношение к пациентам с бессимптомным носительством вируса и проводить комплексное наблюдение за такими больными с обязательными пульсоксиметрией или определением газового состава артериальной крови.

Dyspnea may not be a major symptom of the disease. There are many reports that some patients with COVID-19 did not complain of dyspnea. There is no consensus on the clinical significance of hypoxemia without dyspnea. Several studies suggest that patients with hypoxemia without dyspnea are not protected against the development of adverse COVID-19 outcomes. It is unclear whether hypoxemia with and without dyspnea are two distinct COVID-19 phenotypes or two phases of the disease. There is currently no consensus on the terminology of this condition, its definition, and its mechanisms of formation. It has not been established whether hypoxemia without dyspnea is associated with a favorable outcome of the disease or not. The question of the absence of respiratory response to hypoxia improves the prognosis in such patients remains unresolved. Analysis of currently available data on the mechanisms of hypoxemia development and related manifestations of dyspnea in SARS-CoV-2 virus infection. “Silent hypoxemia” can be observed both in the initial manifestations of respiratory failure and in progression of the disease. Clinical significance of “silent hypoxemia” is that the decrease in physiologic responses and the absence of dyspnea allow patients to feel normal, thus denying the severity of their condition and masking the true severity of the disease. In addition, in elderly patients and patients with diabetes mellitus, suppression of respiratory function in response to hypoxia and the development of “silent hypoxemia” with rapid decompensation should be expected. The attitude to patients with “asymptomatic carriage” of the virus should be reconsidered and comprehensive monitoring of such patients with mandatory pulse oximetry or arterial blood gas test composition should be carried out.

 

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The authors declare that there are no conflicts of interest present.