Innovative treatment of hypercapnia with soda lime in COVID-19: a case report

Abstract

One of the rare consequences of COVID-19 is increasing blood carbon dioxide, which can lead to unconsciousness, dysrhythmia, and cardiac arrest. Therefore, in COVID-19 hypercarbia, non-invasive ventilation (with Bi-level Positive Airway Pressure, BiPAP) is recommended for treatment. If CO₂ does not decrease or continues rising, the patient's trachea must be intubated for supportive hyperventilation with a ventilator (Invasive ventilation). The high morbidity and mortality rate of mechanical ventilation is an important problem of invasive ventilation. We launched an innovative treatment of hypercapnia without invasive ventilation to reduce morbidity and mortality. This new approach could open the window for researchers and therapists to reduce COVID death. To investigate the cause of hypercapnia, we measured the carbon dioxide of the airways (mask and tubes of the ventilator) with a capnograph. Increased carbon dioxide inside the mask and tubes of the device was found in a severely hypercapnic COVID patient in the Intensive Care Unit (ICU). She had a 120kg weight and diabetes disease. Her PaCO₂ was 138mmHg. In this condition, she had to be under invasive ventilation and accept its complication or lethal risk but we decreased her PaCO₂ with the placement of a soda lime canister in the expiratory pathway to absorb CO₂ from the mask and ventilation tube. Her PaCO₂ dropped from 138 to 80, and the patient woke up from drowsiness completely without invasive ventilation, the next day. This innovative method continued until PaCO₂ reached 55 and she was discharged home 14 days later after curing her COVID. Soda lime is used for carbon dioxide absorption in anesthesia machines and we can research its application in hypercarbia state in ICU to postpone invasive ventilation for treatment of hypercapnia.