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Inappropriate Ventilatory Homeostatic Responses in Hospitalized COVID-19 Patients.

Prem Jareonsettasin^1,2, Claudia Zeicu^1,2, Beate Diehl^1,3

¹Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London, United Kingdom.

Frontiers in Neurology

|July 5, 2022

Summary

COVID-19 patients often exhibit tachypnoea (rapid breathing) and hypocapnia (low CO2) without dyspnoea, indicating impaired breathing control. This condition is linked to severe disease and can lead to post-COVID breathing disorders.

Keywords:

COVID-19 breathing pattern disorder dyspnea impaired homeostasis post-covid breathing pattern dysfunction ventilation

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Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device

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Published on: September 24, 2020

Area of Science:

Respiratory Medicine
Critical Care Medicine
Neuroscience

Background:

COVID-19 clinical presentation suggests altered breathing control, characterized by tachypnoea and a discrepancy between clinical and radiological findings.
Limited research exists on the specific drivers of breathing and associated ventilatory/perceptual responses in COVID-19 patients.

Purpose of the Study:

To determine the prevalence of inappropriate ventilatory and perceptual responses in COVID-19 patients.
To analyze the relationship between respiratory rate (RR), dyspnoea, and arterial blood gas (ABG) parameters upon hospital admission.
To investigate post-COVID respiratory sequelae at 6-week follow-up.

Main Methods:

Retrospective cohort study of adult patients hospitalized with confirmed COVID-19 (March-April 2020).
Inclusion criteria: concurrent ABG, RR, and dyspnoea status documented at presentation.
Data collected included patient characteristics, disease severity, and hospital/6-week post-discharge outcomes.

Main Results:

Tachypnoea (RR>20) was observed in 75% of patients, with 36% having pronounced tachypnoea (RR>30).
Impaired ventilatory control (tachypnoea, hypocapnia, alkalosis) occurred in 29%, often without dyspnoea, and was associated with more severe respiratory disease.
Post-discharge, 24% developed new breathing pattern disorders without other neurological findings.

Conclusions:

Impaired homeostatic control of ventilation, including tachypnoea despite hypocapnia, is prevalent in hospitalized COVID-19 patients and linked to severe disease.
Excessive tachypnoea appears driven by peripheral and central mechanisms, not hypoxia.
A significant subset of patients may develop post-COVID breathing pattern disorders.