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In the current COVID-19 pandemic, many patients have an acute respiratory distress syndrome (ARDS). Among mechanisms related to COVID-19 acute respiratory distress syndrome, cytokine storm and secretion of IL-6 play a central role. ARDS management involves intubation for protective mechanical ventilation, deep sedation and curarisation.
During intensive care unit (ICU) hospitalization, improvement of hematosis induces a switch from a controlled ventilation mode to a withdrawal ventilation mode, such as Spontaneous Ventilation with Pressure Support (SP-PS) or Adaptative Support Ventilation (ASV). This step is essential prior to considering complete weaning from controlled ventilation and sometimes ends with a failure. In this case, deterioration of hematosis and/or ventilatory mechanics is observed.
At the same time as withdrawal failure, the investigators observed biological inflammatory rebound in some patients. Therefore, influence of inflammatory biological parameters, including IL-6, on withdrawal failure, needs to be investigated. To this end, the investigators decide to dose different inflammatory markers - such as IL6, C-Reactive Protein (CRP), Procalcitonin (PCT) - in patients with acute respiratory distress syndrome due to COVID-19, during standard of care. Indeed, in patients with acute respiratory distress syndrome not due to COVID-19, the increase in IL6 is a negative prognosis during medical first aid but also when the mechanical ventilation is withdrawn. In addition, IL6 rise is associated with poor prognosis for patients with COVID-19 and longer stays in intensive care.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients with COVID-19 acute respiratory distress syndrome | Other | Patients with acute respiratory distress syndrome due to COVID-19 and requiring mechanical ventilation |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| IL6 assessment | Biological | Blood IL6 will be assessed during trial |
|
| Measure | Description | Time Frame |
|---|---|---|
| Serum concentration of IL6 | Change of blood IL6 concentration during switch from a controlled ventilation mode to a weaning ventilation mode in COVID-19 patients | Up to 72 hours after the start of respiratory weaning |
| Measure | Description | Time Frame |
|---|---|---|
| Serum concentration of CRP and PCT | Change of blood CRP et PCT concentration during switch from a controlled ventilation mode to a weaning mode in COVID-19 patients | Up to 48 hours after the start of respiratory weaning |
| Pulmonary wedge pressure |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Nicolas POUSSARD, MD | Centre Hospitalier Henri Duffaut - Avignon | Principal Investigator |
| Estelle DELAUNAY, MD | Centre Hospitalier Henri Duffaut - Avignon | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Centre Hospitalier Henri Duffaut | Avignon | Vaucluse | 84000 | France |
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| CRP and PCT assessment | Biological | Blood CRP and PCT will be assessed during trial |
|
Change of pulmonary wedge pressure (in mmHg), respiratory rate (in breaths per minute), Fraction of inspired oxygen (FiO2, in percentage), Tidal Volume (in ml/kg) during switch from a controlled ventilation mode to a weaning mode in COVID-19 patients
| Up to 48 hours after the start of respiratory weaning |
| Respiratory rate | Change of respiratory rate (in breaths per minute) during switch from a controlled ventilation mode to a weaning mode in COVID-19 patients | Up to 48 hours after the start of respiratory weaning |
| Fraction of inspired oxygen | Change of Fraction of inspired oxygen (FiO2, in percentage) during switch from a controlled ventilation mode to a weaning mode in COVID-19 patients | Up to 48 hours after the start of respiratory weaning |
| Tidal Volume | Change of Tidal Volume (in ml/kg) during switch from a controlled ventilation mode to a weaning mode in COVID-19 patients | Up to 48 hours after the start of respiratory weaning |
| Days of mechanical ventilation | Duration of mechanical ventilation (days) | At the start of respiratory weaning |
| Number of ventral decubitus | Number of ventral decubitus during mechanical ventilation mode | At the start of respiratory weaning |
| ID | Term |
|---|---|
| D012128 | Respiratory Distress Syndrome |
| D000086382 | COVID-19 |
| ID | Term |
|---|---|
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D012120 | Respiration Disorders |
| D011024 | Pneumonia, Viral |
| D011014 | Pneumonia |
| D012141 | Respiratory Tract Infections |
| D007239 | Infections |
| D014777 | Virus Diseases |
| D018352 | Coronavirus Infections |
| D003333 | Coronaviridae Infections |
| D030341 | Nidovirales Infections |
| D012327 | RNA Virus Infections |
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