Abstract

Case Report

Case reports of observed significant improvement in patients with ARDS due to COVID-19 and maximum ventilatory support after inhalation of sodium bicarbonate

Wardeh A*, Conklin J and Ko M

Published: 19 May, 2020 | Volume 5 - Issue 1 | Pages: 016-019

The emergence of COVID-19 worldwide in an unprecedented pandemic. COVID-19 has a significant mortality, mostly from acute lung injury. We reviewed the available literature from China and Europe in regard to the behavior of SARS-Cov2 and ability to adhere to the cell wall [1,2]. The evidence based literature describes three component for the virus to grant entry to the target cells including Cathepsin B/L (the viral cap protein needed for initial connectivity to the cell wall), the angiotensin converting enzyme 2 and a low PH environment to allow the first connectivity of the virus to the cell wall [3]. The goal of our Case study was to prevent SARS- SARS-Cov2 from entering target cells by raising the airways PH using sodium bicarbonate inhalation. The sodium Bicarbonate inhalation (4.2% concentration) has been used safely in Cystic fibrosis (CF) patients with inspissated mucoid impaction [3,4] and in chloride inhalation toxicity by opposing the effect of the low PH induced by the insulting agent [4,5]. It has not been administered for COVID -19 patients particularly prior to this study. 

Read Full Article HTML DOI: 10.29328/journal.jcicm.1001029 Cite this Article Read Full Article PDF

Keywords:

Medical emergency service; Ambulances; Optimization; Simulation; Response time

References

  1. Chu, V. McElroy, L. Chu, V. Bauman, B. Whittaker, G. The Avian Coronavirus Infectious Bronchitis undergoes direct low PH dependent Fusion activation during entry into the host cells. J Virol. 2006; 80: 3180-3188. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16537586
  2. Yong ZY, Huang Y, Ganesh L, Leung K, Kong wp. et al. pH-Dependent Entry of Severe Acute Respiratory Syndrome Coronavirus Is Mediated by the Spike Glycoprotein and Enhanced by Dendritic Cell Transfer through DC-SIGN. J Virol. 2004; 78: 5642-5650. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC415834/
  3. McShane D, Davies JC, Davies MG, Bush A, Geddes DM, et al. Airway surface PH in subjects with cystic fibrosis. Eur Respir J. 2003; 21: 37-42. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12570106
  4. Gomez CCS, Parazzi PLF, Clinckspoor KJ, Mauch RM, Pessine FBT, et al, safety, tolerability and effectes of sodium bicarbonate inhalation in cystic fibrosis. Clin Drug Investig. 2019; 40: 105-117. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31721070
  5. Aslan S, Kandiş H, Akgun M, Cakir Z, Inandi T, et al. The effect of nebulized sodium bicarbonate treatment on RADS patients due to chlorine gas inhalation. Inhal. Tox. 2006; 18: 895-900. PubMed. https://www.ncbi.nlm.nih.gov/pubmed/16864407
  6. NIH NHLBI ARDS clinical network, mechanical ventilation protocol summary, 2017.
  7. Kis A. Toth L, Kunos L, Gyorgy L, Wanner A. The effect of airway alkalinization by nebulized sodium bicarbonate on airway blood flow. European Res. Journal. 2012; 40: P2143.
  8. Chinese SARS Molecular Consortium. Science 10.1126/science.1092002.
  9. Bosch BJ, Martina BE, Van Der Zee R, Lepault J, Haijema BJ, et al. Severe ARDS due to SARS CoV infection inhibition using spike protein heptad repeated-derived peptides. Proc Natl Acad Sci USA. 2004; 101: 8455-8460. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15150417

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