Determine the Effects of Prone Positioning and NO in COVID-19 ARDS by EIT

Study Overview
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Brief Summary
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We aims to investigate the effects of prone positioning and nitric oxide inhalation in adult patients who is diagnosed with COVID-19 associated acute respiratory distress syndrome by electrical impedance tomography.

Detailed Description
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The investigators aim to investigate the effects of prone positioning and nitric oxide inhalation in adult patients who is diagnosed with COVID-19 associated acute respiratory distress syndrome by electrical impedance tomography (EIT). The EIT assessment is performed in patients ventilated in supine position, supine position with NO inhalation for 1 hour, prone position for 1 hour, prone position for 2 hours with NO inhalation for 1 hour, prone position for 3 hours, prone position for 16 hours, re-supine position for 3 hours. Arterial blood gas (ABG) analysis results, ventilator parameters and hemodynamic parameters are also recorded at each time point.

Official Title
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Determine the Effects of Prone Positioning and Nitric Oxide in Adult COVID-19 Patients With ARDS by Electrical Impedance Tomography

Conditions
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Respiratory Distress Syndrome, Adult, COVID-19

Intervention / Treatment
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* Behavioral: prone postion
* Drug: NO inhalation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: adult patients who have COVID-19-associated acute respiratory distress syndrome Exclusion Criteria: patients who refuse to participate in the study; unable to use EIT, such as open-chest surgery with chest tube placement; have contraindication for prone positioning, including pregnant, post-abdomen surgery within a week; hypercapnic respiratory failure.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Ventilation in supine position<br>Patients are ventilated in supine position. | |
| Ventilation in supine position and NO inhalation<br>Patients are ventilated in supine position with NO inhalation for 1 hour. | Drug: NO inhalation<br>* NO inhalation at 20 ppm<br>|
| Ventilation in prone position for 1 hour<br>Patients are ventilated in prone position for 1 hour. | Behavioral: prone postion<br>* ventilation at prone positioning<br>* Other names: PPV;|
| Ventilation in prone position for 2 hours plus NO inhalation for 1 hour<br>Patients are ventilated in prone position for 1 hour followed by ventilation in prone position with NO inhalation for 1 hour. | Behavioral: prone postion<br>* ventilation at prone positioning<br>* Other names: PPV;Drug: NO inhalation<br>* NO inhalation at 20 ppm<br>|
| Ventilation in prone position for 3 hours<br>Patients are ventilated in prone position for 1 hour followed by ventilation in prone position with NO inhalation for 1 hour. Then they are ventilated in prone position alone for 1 hour. | Behavioral: prone postion<br>* ventilation at prone positioning<br>* Other names: PPV;|
| Ventilation in prone position for 16 hours<br>Patients are ventilated in prone position for 1 hour followed by ventilation in prone position with NO inhalation for 1 hour. Then they are ventilated in prone position alone for 14 hours. | Behavioral: prone postion<br>* ventilation at prone positioning<br>* Other names: PPV;|
| Ventilation in re-supine position for 3 hours<br>Patients are ventilated in supine position for 3 hours followed by ventilation in prone position for 16 hours. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| oxygenation status | To evaluate the oxygenation parameters | 1 day | 
| regional distribution of pulmonary perfusion | To evaluate the effect of prone positon and NO inhalation on pulmonary blood flow distribution. | 1 day | 
| regional distribution of pulmonary ventilation | To evaluate the effect of prone positon and NO inhalation on pulmonary vetilation distribution. | 1 day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Respiratory Distress Syndrome, COVID-19