Emerging evidence suggests that the virus that causes COVID-19 doesn't just attack the lungs -- it can also infect the lining of blood vessels, which may be at least partly to blame for low oxygen levels in some patients.
Some COVID-19 patients have very low oxygen, but don’t seem to know it. They aren’t breathing hard, and while they’re sick, they can talk and sit up and generally seem to be functioning better than someone whose body is starving for oxygen.
Normally, when a part of the lung becomes damaged, tiny blood vessels constrict to redirect blood to areas of the lung that are still working. This mechanism protects the body from a sudden drop in oxygen. Once that happens, it destroys normal mechanisms that match oxygen need to oxygen availability in the air, and people become blue.
Later in the infection, when the lung becomes very damaged from the virus, and the patient starts to really make strenuous efforts to breathe, the lung begins to pick up fluid. The lung shrinks, forming what we call a baby lung, and you get the more conventional ARDS. If they begin to deteriorate, get agitated, short of breath, that is the time to intervene and intubate [with a ventilator].: I strongly recommend lung-protective ventilation. Early on, the patient may be able to take deeper breaths without excessive lung stretch and may feel more comfortable in doing so.
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