Research Article
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: 05/19/2020 | 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
References
- 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
- 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/
- 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
- 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
- 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
- NIH NHLBI ARDS clinical network, mechanical ventilation protocol summary, 2017.
- 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.
- Chinese SARS Molecular Consortium. Science 10.1126/science.1092002.
- 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