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Many questions about management of COVID-19 are still not answered. So, we recruit this study aiming to evaluate improvement of oxygenation in COVID-19 patients with severe ARDS, to improve morbidity and mortality of ICU covid patients, to participate in understanding of real hidden pathophysiology of COVID-19.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control group(group A) | No Intervention | Only sedation for mechanically ventilated COVID patients | |
| Muscle relaxant group(group B) | Experimental | They will receive muscle relaxation treatment for at least 48 hours. Cisatracurium will be given. Short term infusions up to 24 hours will be given in a dose rate of 2-3 mic/Kg/min followed by intervallic shots of 2-5 mg. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| muscle relaxation | Drug | They will receive muscle relaxation treatment for at least 48 hours. Cisatracurium will be given. Short term infusions up to 24 hours will be given in a dose rate of 2-3 mic/Kg/min followed by intervallic shots of 2-5 mg. |
| Measure | Description | Time Frame |
|---|---|---|
| PaO2/FiO2 | ratio of arterial oxygen pressure in millilitre mercury to fraction of inspired oxygen at same time within the arterial blood gas | 48 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Change in lung mechanics | measurement of peak and plateau pressures in cm H2O, airway resistance in cm H2O. s/mL, static and dynamic compliance in Litre/cm H2O and positive end expiratory pressure in cm H2O from ventilator settings | 48 hours |
| SOFA score |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Assiut university, faculty of medicine, anesthesia and ICU and pain management department | Asyut | Asyut Governorate | 71515 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32269085 | Result | Mason RJ. Pathogenesis of COVID-19 from a cell biology perspective. Eur Respir J. 2020 Apr 16;55(4):2000607. doi: 10.1183/13993003.00607-2020. Print 2020 Apr. | |
| 22835162 | Result | Neto AS, Pereira VG, Esposito DC, Damasceno MC, Schultz MJ. Neuromuscular blocking agents in patients with acute respiratory distress syndrome: a summary of the current evidence from three randomized controlled trials. Ann Intensive Care. 2012 Jul 26;2(1):33. doi: 10.1186/2110-5820-2-33. |
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Fulfilment of modified SOFA (Sepsis Organ Failure Assessment) score sheet |
| 48 hours |
| Measurement of tissue perfusion | Measurement of tissue perfusion by serum lactate in mmol/L and jugular venous oxygen saturation % from a sample withdrawn from CVP | 48 hours |
| Monitoring of Alveolar - Arterial Oxygen difference | An arterial canula is to be introduced and a quantity of 0.5 ml of blood samples are obtained from radial artery and arterial blood gas analysis are performed after anti-coagulation by heparin. Alveolar-arterial oxygen tension difference: [P(A-a) DO2] = [(Pa-PH2O) × FiO2%-PaCO2-PaO2]
| 48 hours |
| 28 days survival | 28 days survival | after 28 days |
| Recording risk factors | Recording risk factors as diabetes, renal failure, immunosuppression, smoking, COPD and obesity | 28 days |
| Recording complications | Recording complications as VAP, HAP, neuromuscular weakness | 28 days |
| 20843245 | Result | Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, Jaber S, Arnal JM, Perez D, Seghboyan JM, Constantin JM, Courant P, Lefrant JY, Guerin C, Prat G, Morange S, Roch A; ACURASYS Study Investigators. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010 Sep 16;363(12):1107-16. doi: 10.1056/NEJMoa1005372. |
| 35767435 | Derived | Hohmann F, Wedekind L, Grundeis F, Dickel S, Frank J, Golinski M, Griesel M, Grimm C, Herchenhahn C, Kramer A, Metzendorf MI, Moerer O, Olbrich N, Thieme V, Vieler A, Fichtner F, Burns J, Laudi S. Early spontaneous breathing for acute respiratory distress syndrome in individuals with COVID-19. Cochrane Database Syst Rev. 2022 Jun 29;6(6):CD015077. doi: 10.1002/14651858.CD015077. |
| ID | Term |
|---|---|
| D009126 | Muscle Relaxation |
| ID | Term |
|---|---|
| D009119 | Muscle Contraction |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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