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Radu Țincu, a primary care physician at the Floreasca Hospital ATI department, explained to Digi24 what “happy hypoxia” means, a term that combines two seemingly contradictory English words, “happy” and “hypoxia”. but that actually shows how lazy and dangerous coronavirus disease can be: a patient can have an oxygen saturation of up to 65 percent (as long as it doesn’t have to drop below 93-94 percent) and still be standing without severe symptoms. Then all of a sudden you fall and end up needing intensive care. Some of these patients remain addicted to ventilated oxygen even after the body is rid of the virus.
“When we monitor them, we see that they have a deficit in oxygen saturation, a decrease in this saturation. They come with saturations of 65-70 percent, without necessarily having an alarming symptomatology. Normally, in a patient who has such a low saturation, we expect him to feel the lack of oxygen much more acutely than in reality. This is what is called “silent hypoxia” and “happy hypoxia.” It is a hypoxia that does not create any symptoms until you are intubated. It is a very unstable threshold between the moment you have this saturation – which you support very well – and the moment you end up intubated. We are surprised, he told them, that these patients have very low symptoms compared to their condition, on the one hand, and on the other hand, the tomographic images are catastrophic, it is a bilateral lung damage, with damage of more than 50-60- 70. percent of both lung fields ”, explained Dr. Radu Țincu in Digi24.
A cunning virus
Patients with “happy hypoxia” have no signal, they do not realize what is happening inside their body and this is exactly the “parsimony, cunning” of this virus. They go with symptoms that they tolerate very well to the point where they are intubated directly. I can at most accuse a state of fatigue, apathy. “They were chronically tired and came to the hospital for this evaluation,” explained the doctor.
“If we compare another lung infection that would cause the same degree of desaturation, the patient would be much more symptomatic. Here is the interesting part that determines the SARS-CoV-2: the patient has pulmonary damage greater than 7%, bilateral, but does not feel it until the sudden fall that leads to intubation and mechanical ventilation of these patients “, showed Radu Țincu .
“I have seen patients with such serious pulmonary complications, but what is striking here is the discrepancy between how the patient presents in the hospital and what the radiological image is. Normally, such a patient should have been much more serious, to feel this lung damage in a much more acute way, “added the doctor.
When it comes to intensive care and what happens there
At some point, when this lung damage is severe enough, they can no longer breathe on their own and begin to feel like they don’t have enough oxygen. “At that time, the flow of oxygen increases Facial mask, But at some point, even if it reaches the maximum capacity it can deliver of 15 liters, it still cannot compensate for the lung damage, because there is very little lung left that is still functional.
Then you must take the patient to intensive care for the application of non-invasive mechanical ventilation maneuvers, that is, we apply certain special facial masks to these patients, connected to a ventilation device, or they are patients who a store is connected to his head, that is, a canopy, also connected to a mechanical ventilation device, but this device not only delivers additional oxygen, but also delivers it with a certain pressure and with certain volumes. From that moment on, the patient can no longer carry out these gas exchanges on their own, and more and more controlled ventilation is required.
If we still cannot compensate for the pulmonary deficiency these patients have, we arrive intubation and mechanical ventilation, and for many of them it represents final point, because the patient who is intubated and mechanically ventilated has a very high mortality, fish 60-70 percent. This is not due to intubation, but to the fact that he no longer has sufficient lung capacity to carry out his gas exchanges ”, explained the ATI GP.
The nightmare of a patient who has no more air
Any patient who begs you to help them breathe is, I think, the most impressive, says Dr. Radu Țincu. “I think that of everything that happens in medicine, the patient feels the most acute shortness of breath. It is a terrible feeling to have an oxygen mask on your face and with all this mask, you feel like you don’t have enough air anymore and you can’t breathe anymore. Is the moment these people ask you to do something to help them not feel this acute shortness of breath. It’s as if someone is squeezing your neck and you can’t get out of this grip.. It is an extremely important element and these patients are very traumatized. Many of them become extremely anxious and panicky., because these episodes of dyspnea are repeated, and a patient who knows that this happened the other day is extremely anxious for a new episode, which may be more acute and more severe than the previous one, “said Dr. Radu Țincu.
When the cytokine storm occurs
The cytokine storm, that is, the hyperreaction of our immune system, occurs between 7-8-10 days after infection, when the body begins to overproduce, in an attempt to eliminate the virus, these pro-inflammatory molecules. They don’t just affect the lungs. The earth is the first point of damage, because there is the main fight between the body and the virus.
At the moment when this The systemic inflammatory response encompasses the entire body.We are talking about an inflammation of the heart (myocarditis), an inflammation of the blood vessels, with the risk of these blood clots forming, with the production of heart attacks in different areas, stroke. There are many patients who even develop kidney damage, due to these pro-inflammatory molecules and the obstruction of the renal vessels with clots, detailed Radu Țincu.
When does lung healing start? There may not be a normal life
In the case of these people whose lungs have been severely affected, we are talking about a long-term cure, it is longer than in the case of other diseases. The patients who were released from intensive care, many of them, were left with a bilateral lung damage image up to 3-4 weeks after being discharged from intensive care, which shows that lung recovery is very difficult.
Unfortunately, there are many patients who have remained with lung damage after recovering from SARS-CoV-2, which means a reduced lung capacity, and some of them, sadly, are still at home on oxygen therapy and Requires oxygen devices at home.
At the lung level, the inflammation is so strong, it is like an explosion that simply destroys the normal structure of the lung and then the lung heals with a certain fibrotic sequelae.
It is quite possible that many of these patients no longer lead normal lives after recovering from SARS-CoV-2, said Dr. Radu Țincu.
“We are being attacked”
The worsening of the epidemiological situation in Romania is very clearly seen in hospital emergency rooms, the doctor confirmed in Digi24. “We are assaulted by a very large number of positive and symptomatic patients, and the most common symptomatology is respiratory. There are patients who cannot breathe and feel that they cannot get enough oxygen. (…) We have a very large number of patients, compared to the last weeks we are surprised, there are 10-12-15 symptomatic patients with SARS-CoV-2 in permanent guard rooms and I think this is repeated in all hospitals in the country, ”said Radu Țincu.
In Bucharest, the 100 places that have been supplemented are sold out, they have been exhausted since the weekend and the more COVID-19 patients there are, the more hospitals will have to take care of and this will be to the detriment of the rest of the patients. Radu Țincu pointed out.
Editor: Luana Pavaluca
