COVID-19 Acute Respiratory Distress Syndrome, ICU Acquired Weakness, Sedation Complication
Conditions
Brief summary
Many questions about management of COVID-19 are still not answered. So, we recruit this study aiming to evaluate improvement of oxygenation in COVID-19 patients with severe ARDS, to improve morbidity and mortality of ICU covid patients, to participate in understanding of real hidden pathophysiology of COVID-19.
Interventions
DRUGmuscle relaxation
They will receive muscle relaxation treatment for at least 48 hours. Cisatracurium will be given. Short term infusions up to 24 hours will be given in a dose rate of 2-3 mic/Kg/min followed by intervallic shots of 2-5 mg.
Sponsors
Assiut University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Severe ARDS: PaO2/FiO2 \<200, resistant hypoxemia and tachypnoea (RR \> 40 breath/minute) * Not relieved by high frequency nasal canula or CPAP. * Need for invasive mechanical ventilation (uncooperative)
Exclusion criteria
* Patient relatives' refusal * Not mechanically ventilated. * Combination of female, corticosteroids administration and vecuronium muscle relaxant. * Neuromuscular diseases (especially demyelinating diseases).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PaO2/FiO2 | 48 hours | ratio of arterial oxygen pressure in millilitre mercury to fraction of inspired oxygen at same time within the arterial blood gas |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| SOFA score | 48 hours | Fulfilment of modified SOFA (Sepsis Organ Failure Assessment) score sheet |
| Measurement of tissue perfusion | 48 hours | Measurement of tissue perfusion by serum lactate in mmol/L and jugular venous oxygen saturation % from a sample withdrawn from CVP |
| Monitoring of Alveolar - Arterial Oxygen difference | 48 hours | An arterial canula is to be introduced and a quantity of 0.5 ml of blood samples are obtained from radial artery and arterial blood gas analysis are performed after anti-coagulation by heparin. Alveolar-arterial oxygen tension difference: \[P(A-a) DO2\] = \[(Pa-PH2O) × FiO2%-PaCO2-PaO2\] * \[(760-47) × FiO2%-PaCO2-PaO2\] * \[713 × FiO2%-PaCO2-PaO2\] |
| Change in lung mechanics | 48 hours | measurement of peak and plateau pressures in cm H2O, airway resistance in cm H2O. s/mL, static and dynamic compliance in Litre/cm H2O and positive end expiratory pressure in cm H2O from ventilator settings |
| Recording risk factors | 28 days | Recording risk factors as diabetes, renal failure, immunosuppression, smoking, COPD and obesity |
| Recording complications | 28 days | Recording complications as VAP, HAP, neuromuscular weakness |
| 28 days survival | after 28 days | 28 days survival |
Countries
Egypt
Outcome results
None listed