Transpulmonary Driving Pressure in ARDS COVID19 Patients

Study Overview
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Brief Summary
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A majority (65-85%) of critically ill patients admitted in intensive care units with a confirmed diagnostic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) developed an acute respiratory distress syndrome (ARDS) according to BERLIN criteria. Gattinoni et al. recently described that the ARDS related to SARS-CoV-2 was not a Typical ARDS. Patients affected by this infection present indeed a major hypoxemia, which was surprisingly associated in early phase with a high compliance of respiratory system, more than 50 ml/cm H2O in most cases. The cornerstone of current treatment in case of ARDS is the use of lung protective ventilation, including limited tidal volumes (VT), low end-inspiratory plateau pressures while maintaining sufficiently-high positive end-expiratory pressures (PEEP). However, high levels of PEEP in patients may have detrimental effects on hemodynamic status and fluid retention, particularly when the respiratory system compliance is normal. High PEEP may also lead to overdistension and an increase of alveolar dead space. The airway pressures commonly monitored does not reliably reflect the impact of pressures on the lung parenchyma. Elastance of chest wall may indeed largely influence values of airways pressions. In contrast, transpulmonary pressure obtained using esophageal pressure (Pes) directly reflect lung overdistension risk and lung properties. In order to better understand this new kind of ARDS characterized by modest recruitable profile and to better personalize mechanical ventilation setting and therapy it is obvious to precise transpulmonary pressure.

Official Title
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Transpulmonary Driving Pressure in ARDS COVID19 Patients / TRANSPULMONARY-COVID19

Conditions
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Mechanical Ventilation, SARS-CoV-2, COVID-19

Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Major patients (18-90 years old) Hospitalized following SARS-CoV-2 Mechanical ventilatory support Exclusion criteria: Minor patients

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 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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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of mechanical Ventilation | Duration of mechanical Ventilation | 1 day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants with during of Acute respiratory distress syndrom (SDRA) | Number of Participants with during of Acute respiratory distress syndrom (SDRA) | 1 day | 
| Length of stay in intensive care unit | Length of stay in intensive care unit | 1 day | 
| Mortality | Mortality | 1 day | 
| number of patients with pulmonary complications | number of patients with pulmonary complications | 1 day | 
| Number of Participants with pulmonary stress and strain | Number of Participants with pulmonary stress and strain | 1 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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elastance, Acute respiratory distress syndrome, Esophageal pressure, Pleural pressure