Characterization of the microVAScular Dysfunction in Covid-19 ARDS

Study Overview
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Brief Summary
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The primary endpoint of this research is to establish that the alveolar dead space is significantly higher in patients with COVID-19 ARDS, compared to patients with non-COVID-19 ARDS. Secondarily, the investigators want to establish the prognostic value of the alveolar-dead space (measured iteratively) in patients with COVID-19 and non-COVID-19 ARDS, to establish the respective influences of the biological parameters of endothelial damage, of the biological parameters of coagulopathy, of the parameters set on the artificial ventilator on the value of the alveolar dead space; in ARDS patients with COVID-19 and non-COVID-19 ARDS, to establish the prognostic value of the laboratory parameters of endothelial damage and coagulopathy in patients with COVID-19 and non-COVID-19 ARDS.

Detailed Description
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Endothelial damage and coagulation activation at the lung microvascular level may play an important role in the physiopathology of the COVID-19 ARDS. The project aims to prospectively investigate both bedside pulmonary physiological markers and biological markers of coagulopathy and endothelial dysfunction in COVID-19 and non-COVID-19 ARDS patients.

Official Title
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Characterization of the microVAScular Dysfunction in COvid-19 ARDS

Conditions
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ARDS, Human, COVID-19 Acute Respiratory Distress Syndrome

Intervention / Treatment
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* Diagnostic Test: alveolar dead-space quantification
* Diagnostic Test: Coagulation activation and impaired fibrinolysis explorations
* Diagnostic Test: Endothelial activation / endothelial senescence


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age> 18 years old Invasive mechanical ventilation in place for less than 48 hours Severe or moderate ARDS (defined according to the Berlin classification) Virological confirmation by PCR of SARS-CoV-2 infection (ARDS COVID-19) Lack of virological confirmation by PCR of SARS-CoV-2 infection (ARDS not linked to COVID-19) Patient information Exclusion Criteria: Massive pulmonary embolism Chronic respiratory failure under long-term oxygen therapy Dying patient

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| non-COVID-19 ARDS patients<br>20 patients with acute respiratory distress syndrome (ARDS) unrelated to COVID-19 | Diagnostic Test: alveolar dead-space quantification<br>* measurement of alveolar dead-space based on volumetric capnography<br>Diagnostic Test: Coagulation activation and impaired fibrinolysis explorations<br>* blood sampling: Fibrinolytic components NETs components Elastase-derived fragments of proteins of interest<br>Diagnostic Test: Endothelial activation / endothelial senescence<br>* circulating endothelial cells, E-selectin, endoglin, LVEF-A, LVEFR-2, Angiopoietin -1 and -2, cKit and SDF-1 Willebrand factor (activity, antigen, multimeric analysis )<br>|
| COVID-19 ARDS patients<br>20 patients with acute respiratory distress syndrome (ARDS) linked to COVID-19 | Diagnostic Test: alveolar dead-space quantification<br>* measurement of alveolar dead-space based on volumetric capnography<br>Diagnostic Test: Coagulation activation and impaired fibrinolysis explorations<br>* blood sampling: Fibrinolytic components NETs components Elastase-derived fragments of proteins of interest<br>Diagnostic Test: Endothelial activation / endothelial senescence<br>* circulating endothelial cells, E-selectin, endoglin, LVEF-A, LVEFR-2, Angiopoietin -1 and -2, cKit and SDF-1 Willebrand factor (activity, antigen, multimeric analysis )<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prognostic value of alveolar dead space | Recording the exhaled CO2 curve (side-stream capnography method) and volume curve, as determined by the mechanical ventilator, and computing the signals with the arterial CO2 partial pressure, reflecting the partial pressure of CO2 in the alveoli participating in gas exchanges), determined on arterial blood gas (ABG) sampling. | Up to 28 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prognostic value of the alveolar dead space (measured iteratively) | To establish the link between alveolar dead-space values and Day 20 mortality | 20 days | 
| Prognostic value of the alveolar dead space (measured iteratively) | To establish the link between alveolar dead-space values and Day 20 mortality and Day-28 invasive ventilator-free days. | 28 days | 
| Level of circulating endothelial cells | To describe the biological parameters of endothelial damage and prognostic value | Up to 28 days | 
| Level of progenitor cells | To describe the biological parameters of endothelial damage and prognostic value | Up to 28 days | 
| Level of circulating stem cells | To describe the biological parameters of endothelial damage and prognostic value | Up to 28 days | 
| Level of endothelial proteomics | To describe the biological parameters of endothelial damage and prognostic value | Up to 28 days | 
| Level of D-dimers | To describe the biological parameters of endothelial damage and prognostic value | Up to 28 days | 
| Level of Willebrand Factor | To describe the biological parameters of endothelial damage and prognostic value | Up to 28 days | 
| Level of components of the fibrinolytic system | To describe the biological parameters of endothelial damage and prognostic value | Up to 28 days | 
| Level of fragments of plasminogen | To describe the biological parameters of endothelial damage and prognostic value | Up to 28 days | 
| Level of the components of the NETs (Neutrophil Extracellular Traps) | To describe the biological parameters of endothelial damage and prognostic value | Up to 28 days | 
| Survival rate |  | 90 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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alveolar dead-space, pulmonary biological markers, circulating endothelial cells