This narrative review examines the pathophysiology of silent hypoxia (hypoxemia without dyspnea) in COVID-19, focusing on proposed mechanisms including carotid chemoreceptor impairment, reduced respiratory center sensitivity, and acute vascular distress syndrome (AVDS).
AVDS is the best-supported mechanism, backed by imaging and pathological evidence; carotid body dysfunction and other proposed mechanisms remain incompletely validated and require further study.
Narrative review design limits causal inference; proposed mechanisms are not uniformly validated; no original patient data or quantitative outcomes are reported.
Clinicians should monitor SpO₂ actively in COVID-19 patients who lack subjective dyspnea, as silent hypoxia can precede rapid deterioration. AVDS-related vascular pathology should be considered when evaluating unexplained hypoxemia in these patients.
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