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Understanding the precise pathophysiology of this atypical ARDS will assist researchers and physicians in improving their therapeutic approach. Previous work is limited to postmortem studies, while our report addresses patients under protective lung mechanical ventilation. An open\u2010lung minithoracotomy was performed in 3 patients who developed ARDS related to COVID\u201019 and were admitted to the intensive care unit to carry out a pathological and microbiological analysis on lung tissue biopsy. Diffused alveolar damage with hyaline membranes was found, as well as plurifocal fibrin microthrombi and vascular congestion in all patients\u2019 specimens. Microbiological cultures were negative, whereas qualitative Reversed Transcriptase Polymerase Chain Reaction (RT\u2010PCR) detected SARS\u2010CoV\u20102 in the pulmonary parenchyma and pleural fluid in two patients. COVID\u201019 causes progressive ARDS with onset of severe hypoxemia, underlying a dual mechanism: shunt effect through diffused alveolar damage and dead space effect through thrombotic injuries in microvascular beds. It seems reasonable to manage this ventilation\u2010perfusion ratio mismatch using a high dose of anticoagulant combined with glucocorticoids.<\/jats:p>","DOI":"10.1155\/2020\/2909673","type":"journal-article","created":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T22:08:46Z","timestamp":1607638126000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["What Open\u2010Lung Biopsy Teaches Us about ARDS in COVID\u201019 Patients: Mechanisms, Pathology, and Therapeutic 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