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Could reperfusion pulmonary oedema explain worsening progress in COVID-19 pneumonia?
  1. Muhammet Sukru Paksu1,
  2. Mehtap Kilic2
  1. 1 Paediatrics, VM Medical Park Samsun Hospital, Samsun, Turkey
  2. 2 Paediatric Allergy and Immunology, VM Medical Park Samsun Hospital, Samsun, Turkey
  1. Correspondence to Dr Muhammet Sukru Paksu, Paediatrics, VM Medical Park Samsun Hospital, Samsun 55200, Turkey; sukrupaksu{at}

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Dear editor

The pathogenSARS‐CoV‐2 (also known as 2019‐nCoV) is a novel coronavirus, primarily affecting the respiratory system.1 2 As it is the first time that it has caused infection in humans, information about the pathophysiology of the disease is limited. The most common cause of hospitalisation is pneumonia, and the most severe complication is acute respiratory distress syndrome (ARDS) for SARS‐CoV‐2 infected patients.1–3

Clinical and radiological findings of COVID-19 pneumonia are diverse.1–3 To date, in the literature, some patients have shown relatively good clinical progress and some have developed respiratory failure and ARDS. Interestingly, some patients who had severe clinical and radiological findings have been successfully treated with supportive therapy, including oxygen support, with or without treatment in the prone position.1 2 4

The physiopathological process in ARDS with an atypical clinical course may differ from classic ARDS.1–3 A few reports have tried to provide evidence on this issue but there are not enough studies in the literature. For example, Gattinoni et al identified two types of ARDS phenotypes, L and H types, in their study.3 They also suggested that perfusion might primarily be disrupted in the first type and ventilation in the second.

Bilateral diffuse infiltration and atelectasis have been frequently seen in COVID-19 pneumonia. Sticky mucus, epithelial damage and surfactant deficiency are the leading causes of hypoxaemic respiratory failure …

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  • Handling editor Lara Nicole Goldstein

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MSP planned, revised and submitted the study. MK searched the literature and wrote the study. The submitted version of this manuscript has been seen and approved by the authors.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.