Extra Vascular Lung Water and Pulmonary Permeability in Critically Ill Patients With SARS-CoV-2 (COVID-19)

Study Overview
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Brief Summary
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Acute respiratory distress syndrome (ARDS) is a syndromic definition of an acute lung injury with alteration of biomechanics (lower respiratory system compliance) mostly associated with increased lesional edema. Increase in Pulmonary Vascular Permeability Index (PVPI) accompanied with accumulation of excess Extravascular Lung Water (EVLW) is the hallmark of ARDS. In routine clinical practice, the investigators measure the EVLW and PVPI in ARDS patients, as suggested by expert's recommendations, using a transpulmonary thermodilution (TPTD) technique. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly recognized illness that has spread rapidly throughout Wuhan (Hubei province) to other provinces in China and around the world. Most critically ill patients with SARS-CoV-2 will present the criteria for the definition of ARDS. However, many of these patients have a particular form of ARDS with severe hypoxemia often associated with near normal respiratory system compliance. This combination is almost never seen in severe ARDS. Thus other mechanisms (including probably vascular mechanisms), that are still poorly described, have to be involved in SARS-CoV-2. EVLW and PVPI have never been assessed in SARS-CoV-2 mechanically ventilated patients. The aim of this study is to evaluate these two parameters in order to best characterize and understand the mechanisms related to SARS-CoV-2. Based on observation of several cases in intensive care units (ICU), the investigators hypothesize that there are following different SARS-CoV-2 patterns: Nearly normal compliance, low lung recruitability, normal EVLW and low PVPI. Low compliance due to increased edema, high lung recruitability, high EVLW and high PVPI.

Official Title
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Assessment of Extra Vascular Lung Water and Pulmonary Permeability by Transpulmonary Thermodilution in Critically Ill Patients With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

Conditions
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COVID-19, Pneumonia, Acute Respiratory Distress Syndrome

Participation Criteria
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Eligibility Criteria
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Inclusion criteria: COVID-19 critically ill patients Invasive mechanical ventilation Exclusion criteria: Age under 18 Pregnancy Legally protected adults Contra-indication of using PiCCO device: jugular venous thrombosis, or severe chronic femoral/iliac artery occlusive disease

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 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 |
| --- | --- | --- |
| Changes of Extra Vascular Lung Water | EVLW (ml/kg) measured by a PiCCO device using TPTD thermodilution | Since intubation at day 0 and measured repetitively by 6 hours until day 3 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes of Pulmonary Vascular Permeability Index | PVPI measured by a PiCCO device using TPTDventilation, duration of ICU length of stay, ICU mortality | Since intubation at day 0 and measured repetitively by 6 hours until day 3 | 
| Changes of pulmonary compliance | Changes of pulmonary compliance (ml/mmHg) | Since intubation at day 0 and measured repetitively by 6 hours until day 3 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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ARDS, ICU, Transpulmonary thermodilution, Extravascular lung water, Pulmonary Vascular Permeability Index