Author(s)

Luiz Gonzaga Francisco de Assis Barros D’Elia Zanella^1,2,3

¹Infectious Diseases Department (MI-HSPE), Hospital do Servidor Público do Estado de São Paulo, São Paulo, Brazil.
²PhD Program in Allergy and Immunopathology, School of Medicine, University of São Paulo, São Paulo, Brazil.
³Emergency and Urgency Department, University Hospital of University of São Paulo, Butantã, São Paulo, Brazil.

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.

Acute Respiratory Distress Syndrome, Cardiovascular System, Critical Care, COVID-19, Lactate

Zanella, L. (2022) 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. Open Journal of Emergency Medicine, 10, 19-47. doi: 10.4236/ojem.2022.101003.