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
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