Author: Dr. Ahmed Farhan     Published: 2 years ago 3 Replies

A young male patient has been admitted with severe COVID-19 infection. He is maintaining oxygen saturaion with 4 litres of oxygen.

He was admitted in January 2021 for severe COVID-19 infection and remained on BIPAP

He was alright until a few days back when he got re-infection.

His blood gases are suggestive of type 2 respiratory failure ( pCO2 of 80 mmHg) with a mild degree of hypoxemia.

He is not a smoker and chest examination only reveals fine crepitations at the bases.

What could be the cause of severe hypercapnea in this patient?

since patient previously suffered from severe Covid 19 infection and he remained on bipap now presented with reinfection with type  2 failure this presentation may be due to 

* lung fibrosis secondary to ARDS 

* Restrictive lung disease 

*Pulmonary embolism

secondly look at status of heart to rule out right to left shunt or Pulmonart arterial hypeetension or angina

mahnoor yousaf, 2 years ago

Arteriovenous shunting should be looked at in this case, since hypercapnea is disproportionate to the degree of hypoxemia.

What tests can we do do diagnose Arteriovenous shunting in this patient?

Dr. Ahmed Farhan, 2 years ago

Transthoracic contrast echocardiography TTCE ( bubble study) 

when microbubbles appear in LA 

within one cardiac cycle of there appearance in RA :: intra cardiac shunt 

within 3-8 cycles :: intrapulmonary shunt 

within 01-03 cardiac cycles :: location of shunt is indeterminate 

100%oxygenation :: to calculate shunt fraction and >5% is abnormal 

CT chest contrast enhanced 

Three dimensional contrast emhanced MR angiography 

Pulmonary angiogram:; if Pulmonary AVM seen on CT 

mahnoor yousaf, 2 years ago

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