We reviewed data from medical records: demographic; clinical, laboratory; blood gas; chest tomography (CT); the oxygen therapy support; and mechanical ventilation (IMV) requirements, all of which were reviewed and recorded by investigators. Clinical outcomes were followed up to 1 May 2022.
In this case–control study, we compared fluid management applied during eight days in patients with acute lung injury for COVID-19: a conservative strategy for the control group, and NEGBAL approach for the NEGBAL group.
The control group received standard treatment. It was based on dexamethasone 6 mg/day, enoxaparin 40 mg/day, oxygen supplement (nasal cannula, reservoir mask, HFNC), invasive or non-invasive mechanical ventilation and standard care.
The NEGBAL group underwent, in addition to the standard care, a treatment with furosemide in continuous intravenous infusion: the NEGBAL approach.
Inclusion criteria were as follows: (1) age older than 18 years; (2) confirmed diagnosis of COVID-19 through real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay with samples obtained from nasopharyngeal swab or positive antinucleocapsid IgM antibodies; (3) PaO2/FiO2 (ratio of arterial oxygen partial pressure to fractional inspired oxygen) < 300; and (4) tomographic evidence of acute pulmonary edema, defined as ground glass infiltration, dilated superior vena cava, large pulmonary arteries, and dilated right ventricle or dilated cardiac axis.
Exclusion criteria were as follows: (1) patients with indication for diuretics for another reason; (2) renal failure; (3) cardiac failure; (4) hepatic failure; (5) hypernatremia or hyponatremia; (6) hypotension, use of inotropics or shock; (7) receiving antivirals or monoclonal antibodies.
CTs were performed upon admission to ICU, CT controls were scheduled for day 4 (+/− 1 day), day 8 (+/− 1 day), and day 12 (+/− 1 day). A 1.5 mm slice thickness and 1.5 mm interval were used for the axial image.
For the evaluation of CT infiltrates, the scoring was as described by Pan F et al. [66 (link)]. The measurement of the superior vena cava diameter (Ø svc) in the CT was performed just above the arch of the azygos veins.
In this case–control study, we compared fluid management applied during eight days in patients with acute lung injury for COVID-19: a conservative strategy for the control group, and NEGBAL approach for the NEGBAL group.
The control group received standard treatment. It was based on dexamethasone 6 mg/day, enoxaparin 40 mg/day, oxygen supplement (nasal cannula, reservoir mask, HFNC), invasive or non-invasive mechanical ventilation and standard care.
The NEGBAL group underwent, in addition to the standard care, a treatment with furosemide in continuous intravenous infusion: the NEGBAL approach.
Inclusion criteria were as follows: (1) age older than 18 years; (2) confirmed diagnosis of COVID-19 through real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay with samples obtained from nasopharyngeal swab or positive antinucleocapsid IgM antibodies; (3) PaO2/FiO2 (ratio of arterial oxygen partial pressure to fractional inspired oxygen) < 300; and (4) tomographic evidence of acute pulmonary edema, defined as ground glass infiltration, dilated superior vena cava, large pulmonary arteries, and dilated right ventricle or dilated cardiac axis.
Exclusion criteria were as follows: (1) patients with indication for diuretics for another reason; (2) renal failure; (3) cardiac failure; (4) hepatic failure; (5) hypernatremia or hyponatremia; (6) hypotension, use of inotropics or shock; (7) receiving antivirals or monoclonal antibodies.
CTs were performed upon admission to ICU, CT controls were scheduled for day 4 (+/− 1 day), day 8 (+/− 1 day), and day 12 (+/− 1 day). A 1.5 mm slice thickness and 1.5 mm interval were used for the axial image.
For the evaluation of CT infiltrates, the scoring was as described by Pan F et al. [66 (link)]. The measurement of the superior vena cava diameter (Ø svc) in the CT was performed just above the arch of the azygos veins.
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