Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach

Journal of Clinical Medicine

Marcelo Rodriguez¹  Claudio Milicchio²  Diego Quiros²  Eduardo Garcia Saiz²  Virginia De Langhe³  Federico Magdaleno³  Veronica Alo⁴  Vanina Dos Santos⁴  Patricio Zanardi⁴  Andrea Villoldo⁴  Jose L. Francisco Santos⁴  Micaela Coria⁴  Giuliana Murialdo⁴ 

[1] Cardiology Service, Clinica Colon, Mar del Plata, Buenos Aires 7600, Argentina;Diagnostic Imaging Service, Clinica Colon, Mar del Plata, Buenos Aires 7600, Argentina;Diagnostic Imaging Service, Hospital Privado del Sur. Bahía Blanca, Buenos Aires 8000, Argentina;Intensive Care Unit, Clinica Colon, Mar del Plata, Buenos Aires 7600, Argentina;

关键词: COVID-19;    furosemide;    edema;    volume overload;    diuretic;    NEGBAL;   

DOI  :  10.3390/jcm10235599

来源: DOAJ

【 摘 要 】

In COVID-19, pulmonary edema has been attributed to “cytokine storm”. However, it is known that SARS-CoV2 promotes angiotensin-converting enzyme 2 deficit, increases angiotensin II, and this triggers volume overload. Our report is based on COVID-19 patients with tomographic evidence of pulmonary edema and volume overload to whom established a standard treatment with diuretic (furosemide) guided by objectives: Negative Fluid Balance (NEGBAL approach). Retrospective observational study. We reviewed data from medical records: demographic, clinical, laboratory, blood gas, and chest tomography (CT) before and while undergoing NEGBAL, from 20 critically ill patients. Once the NEGBAL strategy was started, no patient required mechanical ventilation. All cases reverted to respiratory failure with NEGBAL, but subsequently two patients died from sepsis and acute myocardial infarction (AMI). The regressive analysis between PaO2/FiO2BAL and NEGBAL demonstrated correlation (p < 0.032). The results comparing the Pao2Fio2 between admission to NEGBAL to NEGBAL day 4, were statistically significant (p < 0.001). We noted between admission to NEGBAL and day 4 improvement in CT score (p < 0.001), decrease in the superior vena cava diameter (p < 0.001) and the decrease of cardiac axis (p < 0.001). Though our study has several limitations, we believe the promising results encourage further investigation of this different pathophysiological approach.

【 授权许可】

Unknown