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Article

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

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Intensive Care Unit, Clinica Colon, Mar del Plata, Buenos Aires 7600, Argentina
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Cardiology Service, Clinica Colon, Mar del Plata, Buenos Aires 7600, Argentina
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Diagnostic Imaging Service, Hospital Privado del Sur. Bahía Blanca, Buenos Aires 8000, Argentina
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Diagnostic Imaging Service, Clinica Colon, Mar del Plata, Buenos Aires 7600, Argentina
*
Author to whom correspondence should be addressed.
Academic Editor: Jihad Mallat
J. Clin. Med. 2021, 10(23), 5599; https://doi.org/10.3390/jcm10235599
Received: 20 October 2021 / Revised: 19 November 2021 / Accepted: 26 November 2021 / Published: 28 November 2021
(This article belongs to the Collection Pulmonary and Critical Care Practice in the Pandemic of COVID-19)
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. View Full-Text
Keywords: COVID-19; furosemide; edema; volume overload; diuretic; NEGBAL COVID-19; furosemide; edema; volume overload; diuretic; NEGBAL
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MDPI and ACS Style

Santos, J.L.F.; Zanardi, P.; Alo, V.; Rodriguez, M.; Magdaleno, F.; De Langhe, V.; Dos Santos, V.; Murialdo, G.; Villoldo, A.; Coria, M.; Quiros, D.; Milicchio, C.; Garcia Saiz, E. Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach. J. Clin. Med. 2021, 10, 5599. https://doi.org/10.3390/jcm10235599

AMA Style

Santos JLF, Zanardi P, Alo V, Rodriguez M, Magdaleno F, De Langhe V, Dos Santos V, Murialdo G, Villoldo A, Coria M, Quiros D, Milicchio C, Garcia Saiz E. Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach. Journal of Clinical Medicine. 2021; 10(23):5599. https://doi.org/10.3390/jcm10235599

Chicago/Turabian Style

Santos, Jose L.F., Patricio Zanardi, Veronica Alo, Marcelo Rodriguez, Federico Magdaleno, Virginia De Langhe, Vanina Dos Santos, Giuliana Murialdo, Andrea Villoldo, Micaela Coria, Diego Quiros, Claudio Milicchio, and Eduardo Garcia Saiz. 2021. "Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach" Journal of Clinical Medicine 10, no. 23: 5599. https://doi.org/10.3390/jcm10235599

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