Physiological mechanism of resistant hypoxemia during dialysis of COVID 19 patient: a case report.

Abstract

Chronic kidney disease (CKD) is characterized by loss of kidney function and generally it is associated with several alterations in pulmonary functions, including restriction, obstruction, and impaired diffusion capacity. It became challenging to maintain oxygenation in a CKD patient associated with COVID 19 on non-invasive ventilation (NIV). In patients with end stage renal disease (ESRD), several factors likes, fluid overload, anaemia, immune suppression, extraosseous calcification, malnutrition, electrolyte imbalance, and acid-base disorder affecting the lungs indirectly. Here we are reporting NIV failure in two COVID 19 patients during dialysis. Both patients were stable on NIV before starting dialysis and underwent oxygen desaturation and shifted to invasive mechanical ventilation during hemodialysis. The possible mechanism of the oxygen desaturation is alveolar hypoventilation in the absence of hypercapnia, which may be due to the removal of CO2 from the body by some route (dialysate) other than the lungs.

Keywords

• covid-19
• chronic kidney disease
• haemodialysis
• non-invasive ventilation
• case report.