So we only have a little bit of damage to the lung, but the circulatory system's not routing around it normally, so you have SUPER bad hypoxemia.
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The other conclusion is that you want to intubate when the inspiratory pressure swings are starting to get big, as controlling the breathing rate can *prevent* additional lung injury.
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"As esophageal pressure swings increase from 5 to 10 cmH2O—which are generally well tolerated—to above 15 cmH2O, the risk of lung injury increases and therefore intubation should be performed as soon as possible."
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Also, if we could figure out *how* COVID19 blocks hypoxic vasoconstriction, and find a way to make it *stop*, those "silent hypoxemic" patients could get their V/Q back to normal, and thus would no longer be hypoxemic (since they don't have much lung damage to begin with.)
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