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

2021 ◽  
Vol 10 (23) ◽  
pp. 5599
Author(s):  
Jose L. Francisco Santos ◽  
Patricio Zanardi ◽  
Veronica Alo ◽  
Marcelo Rodriguez ◽  
Federico Magdaleno ◽  
...  

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.

2017 ◽  
Vol 20 (5) ◽  
pp. 231
Author(s):  
Shuyang Lu ◽  
Lai Wei ◽  
Chunsheng Wang

In this case report, we present the delayed diagnosis of an atypical partial anomalous pulmonary venous connection, which was initially misdiagnosed as primary pulmonary arterial hypertension. It was difficult to make a conclusive diagnosis using transthoracic echocardiography (TTE), because the two high right superior pulmonary veins drained into the superior vena cava and limited the shunt of patent foramen ovale. Preoperative TTE only showed right heart volume overload, pulmonary arterial hypertension, and severe tricuspid valve insufficiency. A chest CT-angiography (angio-CT) finally found the anomalous right superior pulmonary venous connection, which was further confirmed by surgery. The postoperative course was uneventful. 


1961 ◽  
Vol 41 (5) ◽  
pp. 505-508 ◽  
Author(s):  
Richard W. Snodgrass ◽  
Sherman M. Mellinkoff

1970 ◽  
Vol 09 (03) ◽  
pp. 149-160 ◽  
Author(s):  
E. Van Brunt ◽  
L. S. Davis ◽  
J. F. Terdiman ◽  
S. Singer ◽  
E. Besag ◽  
...  

A pilot medical information system is being implemented and currently is providing services for limited categories of patient data. In one year, physicians’ diagnoses for 500,000 office visits, 300,000 drug prescriptions for outpatients, one million clinical laboratory tests, and 60,000 multiphasic screening examinations are being stored in and retrieved from integrated, direct access, patient computer medical records.This medical information system is a part of a long-term research and development program. Its major objective is the development of a multifacility computer-based system which will support eventually the medical data requirements of a population of one million persons and one thousand physicians. The strategy employed provides for modular development. The central system, the computer-stored medical records which are therein maintained, and a satellite pilot medical data system in one medical facility are described.


1993 ◽  
Vol 29 (4) ◽  
pp. 704
Author(s):  
Hyun Sook Kim ◽  
Hyung Jin Kim ◽  
Hyeng Gon Lee ◽  
In Oak Ahn ◽  
Sung Hoon Chung

Sign in / Sign up

Export Citation Format

Share Document