TITLE:
Out of Sight, Out of Mind, Right? Not in COVID-19 Shock or Anaerobic and Exhaustive Shock versus Septic Shock Dilemma That Means to Live or Die. Emergency Attention and a Necessity of Trials
AUTHORS:
Luiz Gonzaga Francisco de Assis Barros D’Elia Zanella
KEYWORDS:
Acute Respiratory Distress Syndrome, Cardiovascular System, Critical Care, COVID-19, Lactate
JOURNAL NAME:
Open Journal of Emergency Medicine,
Vol.10 No.1,
February
24,
2022
ABSTRACT: Background: COVID-19 brought challenges that did not end after a two-year pandemic.
From more straightforward changes in habits to studying to understand the
enigmatic parasite-host relationship, we can better manage the patient infected
with SARS-CoV-2 even with a vaccine full of doubts and antivirals that do not
correctly cover the viral period. SARS-CoV-2 brought the chronic inflammation
now called “The Long COVID-19 Syndrome” (LCS), something still little talked
about, but we already see deaths due to non-identification of this inflammatory
syndrome that can lead to shock. Theory: LCS Shock is due to a long
period of metabolic stress, reflecting the shift from inflammation to oxidative
stress and innate immunity, and does not respond to antimicrobials, as its main
component is inflammatory, although there may be conjoined bacterial
translocation. Thus, we are losing patients to a new syndrome confused with
sepsis and septic shock. While septic shock (SS) responds to antimicrobials,
Inflammatory Shock (ISc) does not respond to antimicrobials alone, requiring
high doses of corticosteroids. Review: This study shows that we need to
differentiate SS and ISC, as the treatment is different. The review shows that
Lactate, LDH and the presence of new/recent cardiac changes and bradycardia in
the face of a status where there should be tachycardia as the usual response
can differ ISC from SS. Maybe the main responsible for high LDH is Warburg
Effect. Conclusion: We have a dilemma that requires clinical studies
that routinely match high doses of corticosteroids (until there is something
better to be done) and bring laboratory and imaging differences to diagnose SS vs ISc better.