Acute Respiratory Distress Syndrome (ARDS), COVID-19, Corona Virus Infection
Conditions
Brief summary
The purpose of our prospective monocentric, randomized, controlled trial is to evaluate the effects of intravenous lidocaine on gas exchange and inflammation in acute respiratory distress syndrome (ARDS) due or not to Covid-19 pneumonia. Half of the patients will receive intravenous lidocaine and the other half will receive intravenous NaCl 0,9 % as placebo.
Interventions
DRUGLidocaine 2%
the lidocaine infusion protocol is a bolus of 1 mg/kg (ideal weight), followed by 3mg/kg/h for the first hour, 1.5 mg/kg/h for the second hour, 0.72 mg/kg/h for the next 22 hours, and then 0.6mg/kg/h for 14 days or until extubation.
DRUGControl
The NaCl 0,9% infusion protocol is a bolus of 0.05 ml/kg (ideal weight), followed by 0.15 ml/kg/h for the first hour, 0.075 ml/kg/h for the second hour, 0.36 ml/kg/h for the next 22 hours, and then 0.03 ml/kg/h for 14 days or until extubation.
Sponsors
University Hospital, Strasbourg, France
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥18 years * Hospitalized in ICU * Presence of all of the following conditions, within one week of a clinical insult or new or worsening respiratory symptoms: * PaO2/FiO2 \<300 mmHg with positive end-expiratory pressure (PEEP) ≥5 cmH2O * Bilateral opacities not fully explained by cardiac failure or fluid overload * Intubated and sedated for mechanical protective ventilation * Affiliation to the French Sociale security * Beta HCG negative for women For Covid-19 subgroup: \- Covid-19 infection (RT-PCR \< 7 days and/or another approved diagnostic technique and/or typical CT appearance of COVID-19 pneumonia
Exclusion criteria
* Allergy to amide local anesthetics * Acute porphyria * Disorders of atrioventricular conduction requiring a non-done permanent electrosystolic pacing * Uncontrolled epilepsy * Fluvoxamine treatment * Class III antiarrythmic agent treatments (amiodarone, dronedarone) * Class I antiarythmic agent (quinidine, disopyramide, hydroquinidine, flecainid, propafenone) * Hepatocellular insufficiency defined by PT\<15% in the absence of anti-vitamin K * Patient under a tutelage measure or placed under judicial protection * Known pregnancy * Breastfeeding
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| alveolar-capillary gas exchange after two days of treatment | At 48 hours after the first treatment administration | PaO2/FiO2 ratio |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Ventilator-free days | At day 28 and at day 90 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Measure the effects of Intravenous Lidocaine on Biomarkers : Ferritin | At Day 0, day 2, day 7, day 14 and at day 21 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Measure the effects of Intravenous Lidocaine on Biomarkers : bicarbonates | At Day 0, day 2, day 7, day 14 and at day 21 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Measure the effects of Intravenous Lidocaine on Biomarkers : CRP | At Day 0, day 2, day 7, day 14 and at day 21 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Measure the effects of Intravenous Lidocaine on Biomarkers : LDH | At Day 0, day 2, day 7, day 14 and at day 21 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Measure the effects of Intravenous Lidocaine on Biomarkers : IL-6 | At Day 0, day 2, day 7, day 14 and at day 21 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Measure the effects of Intravenous Lidocaine on Biomarkers : Tropo HS | At Day 0, day 2, day 7, day 14 and at day 21 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Measure the effects of Intravenous Lidocaine on Biomarkers : Triglycerides | At Day 0, day 2, day 7, day 14 and at day 21 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Measure the effects of Intravenous Lidocaine on Biomarkers : CBC with lymphocytes count | At Day 0, day 2, day 7, day 14 and at day 21 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Antithrombotic activity of Intravenous Lidocaine on platelets | At Day 0, day 2, day 7, day 14 and at day 21 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Antithrombotic activity of Intravenous Lidocaine on ACT ratio | At Day 0, day 2, day 7, day 14 and at day 21 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Antithrombotic activity of Intravenous Lidocaine on fibrinogen | At Day 0, day 2, day 7, day 14 and at day 21 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Antithrombotic activity of Intravenous Lidocaine on D-Dimers | At Day 0, day 2, day 7, day 14 and at day 21 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| alveolar-capillary gas exchange From day 0 to day 21 or until coming out of intensive care | From day 0 to day 21 or until coming out of intensive care | PaO2/FiO2 ratio : a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Antithrombotic activity of Intravenous Lidocaine on thromboembolic events | At Day 0, day 2, day 7, day 14 and at day 21 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Plasma concentration of albumin and Lidocaine | 4 hours after first administration, at day 2, day 7, day 14 and at day 21 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Search for hemodynamic dysfynction: Blood pressure measurement in mmHg | daily from day one to day 14 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. Blood pressure in mmHg will be measured |
| Search for hemodynamic dysfynction: Cardiac frequency in beats per minute will be assessed | daily from day one to day 14 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. Cardiac frequency in beats per minute will be assessed |
| Search for hemodynamic dysfynction: Sinus rythm will be assessed | daily from day one to day 14 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. Sinus rythm will be assessed |
| Search for hemodynamic dysfynction: Vasopressors and inotropes drugs use will be reported | daily from day one to day 14 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. Vasopressors and inotropes drugs use will be reported |
| Search for hemodynamic dysfynction: EKG : PR, QRS, QTc intervals in ms will be measured | daily from day one to day 14 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. EKG : PR, QRS, QTc intervals in ms will be measured |
| ICU ileus: laxation response | daily from Day 0 to Day 28 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Opioids, sedative and curare sparing effect (drugs dosage) | daily from Day 0 to Day 28 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Evaluate the impact of Lidocaine IV on ICU outcomes : re-intubation | From Day0 to Day28 and at Day90 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Evaluate the impact of Lidocaine IV on ICU outcomes : ICU length of stay | From Day0 to Day28 and at Day90 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Evaluate the impact of Lidocaine IV on ICU outcomes : ICU complications | From Day0 to Day28 and at Day90 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Cough at extubation time or in the 24 hours after extubation or weaning from respiratory support (in case of tracheostomy) | extubation day | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
| Antithrombotic activity of Intravenous Lidocaine on TEG | At Day 0, day 2, day 7, day 14 and at day 21 | a comparison will be made between Lidocaine and control groups in patients with acute respiratory distress syndrome (ARDS) due to Covid-19 and in patients with ARDS without Covid-19. |
Countries
France
Outcome results
None listed