How to increase cellular oxygen availability in COVID-19?

Can affinity of hemoglobin to oxygen to be a prognostic marker in critically ill COVID-19 patients?

Background

This study's objective is to determine the slope of the hemoglobin oxygen dissociation curve in critically ill patients who have COVID-19 along with blood gas measurements and how mortality might be impacted by this circumstance.

Aim

It has been reported that the hemoglobin oxygen dissociation curve is not different from healthy patients in COVID-19. However, there are insufficient data on the behavior of the curve in patients who require intensive care.

Patients and Methods

This retrospective study was conducted between 01.03.2021 and 01.07.2021 with patients who were followed up due to COVID-19 in adult intensive care unit. P50 and lactate value obtained from in vitro calculated blood gas analysis. The survival status of the patients was recorded.

Results

The mean P50 value at the admission of nonsurvivors was significantly higher than survivors. In correlation analysis, a significant positive correlation was seen between P50, mortality, and lactate level at admission. SpO₂, PaO₂/FiO₂ ratio, and length of stay in intensive care unit were significantly negatively correlated with P50 levels.

Conclusion

A right shift in the hemoglobin oxygen dissociation curve is associated with mortality. Lactate levels were also associated with a right shift. Prospective experimental studies are needed to provide a better understanding of this process.

The Impact of COVID-19 Infection on Oxygen Homeostasis: A Molecular Perspective

The novel coronavirus (2019-nCoV/SARS-CoV-2) causes respiratory symptoms including a substantial pulmonary dysfunction with worsening arterial hypoxemia (low blood oxygenation), eventually leading to acute respiratory distress syndrome (ARDS). The impact of the viral infection on blood oxygenation and other elements of oxygen homeostasis, such as oxygen sensing and respiratory mitochondrial mechanisms, are not well understood. As a step toward understanding these mechanisms in the context of COVID-19, recent experiments revealed contradictory data on the impact of COVID-19 infection on red blood cells (RBCs) oxygenation parameters. However, structural protein damage and membrane lipid remodeling in RBCs from COVID-19 patients that may impact RBC function have been reported. Moreover, COVID-19 infection could potentially disrupt one, if not all, of the other major pathways of homeostasis. Understanding the nature of the crosstalk among normal homeostatic pathways; oxygen carrying, oxygen sensing (i.e., hypoxia inducible factor, HIF) proteins, and the mitochondrial respiratory machinery may provide a target for therapeutic interventions.