Abstract: Case Report More Information Case reports of observed significant improvement in patients with ARDS due to COVID-19 and maximum ventilatory support after inhalation of sodium bicarbonate *Address for Correspondence: Anas Wardeh, Department of Critical Care Medicine, Uniontown Hospital, Uniontown, PA, USA, Tel: 508-479-4213; Email: awardeh1@aol.com; awardeh1@icloud.com Wardeh A*, Conklin J and Ko M The emergence of COVID-19 worldwide in an unprecedented pandemic. COVID-19 has a signi icant 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 irst 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 ibrosis (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. Methods Four patients required mechanical ventilation due to COVID-19 pneumonia. All patients have proven positive COVID-19 RNA collected from the airway’s secretions. Each one of the patients received inhaled 4.2% sodium bicarbonate as a salvage therapy. All four patients had severe adult respiratory distress syndrome (ARDS) and required 100 % Fraction of inspired oxygen (FIO2). Due to severe hypoxia despite 100% FIO2, these patients were placed on Positive end expiratory pressure (PEEP) of 15 to maintain their Oxygen saturation at 87% at minimum. Also, a standard PEEP of 15 was used throughout the process to keep the alveoli patent to https://doi.org/10.29328/journal.jcicm.1001029 How to cite this article: Wardeh A, Conklin J, Ko M. Case reports of observed significant improvement in patients with ARDS due to COVID-19 and maximum ventilatory support after inhalation of sodium bicarbonate. J Clin Intensive Care Med. 2020; 5: 016-019. DOI: 10.29328/journal.jcicm.1001029 Department of Critical Care Medicine, Uniontown Hospital, Uniontown, PA, USA