COVID-19, Critical Illness, Hypoxemic Respiratory Failure, Mechanical Ventilation Complication, Neurocognitive Dysfunction
Conditions
Brief summary
Critically ill COVID-19 patients with acute respiratory failure, in the intensive care unit (ICU), often feature high respiratory drive, determining large inspiratory efforts resulting in high pressures and global and regional over-distention, leading to lung injury. SARS-CoV-2 neurotropic-penetration in control centers in medulla oblongata might contribute to dysregulation and to excessively high respiratory drive observed in these patients. These pathophysiological conditions may often lead to the development of patient-ventilator asynchronies in aptients under mechanical ventilation, again leading to high tidal volumes and increased lung injury. These phenomena can contribute to prolonged duration of mechanical ventilation and ICU length of stay, but also can result in long term adverse outcomes like emotional/psychological and cognitive sequelae. All them compromising the quality of life of critically ill survivors after ICU discharge. The investigators will conduct a multicenter study in adult critically ill COVID-19 patients with hypoxemic respiratory failure, aiming to: 1) characterize incidence and clustering of high respiratory drive by developing algorithms, 2) apply artificial intelligence in respiratory signals to identify potentially harmful patient-ventilator interactions, 3) characterize cognitive and emotional sequelae in critically ill COVID-19 survivors after ICU discharge and 4) identify sets of genes and transcriptomic signatures whose quantified expression predisposed to asynchronies and cognitive impairment in critically ill COVID-19 patients.
Interventions
None listed
Sponsors
Althaia Xarxa Assistencial Universitària de Manresa
Hospital Universitario Central de Asturias
Corporacion Parc Tauli
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults patients with hypoxemic respiratory failure. * Admitted to ICU. * Mechanical ventilation or high flow nasal cannula
Exclusion criteria
* Neurologic patients with brainsteam affection.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Respiratory drive | From day 1 at ICU until the day were the criteria of PaFi > 300 is met, up to 30 days | To characterize the high respiratory drive phenomena in critically ill COVID-19 patients undergoing mechanical ventilation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cluster of high respiratory drive | From day 1 of mechanical ventilation until the day of mechanical ventilation discontinuation, up to 30 days | To describe the incidence and clustering of high respiratory drive throughout mechanical ventilation period by the development of specific algorithms. |
| Artificial intelligence algorithms | From day 1 of mechanical ventilation until the day of mechanical ventilation discontinuation, up to 30 days | To apply artificial intelligence (machine learning, deep learning, pattern/image recognition and entropy) in physiologic respiratory signals to identify potentially harmful patient-ventilator interactions. |
| Neurocognitive disorders | 1 month after ICU discharge and 1 year after ICU discharge | To characterize cognitive and emotional sequelae in critically ill COVID-19 survivors at 1 month and 1 year after ICU discharge. |
| Gene expression | day 1 of ICU admission | Application of massive sequencing of gene expression and circulating micro-RNA in blood samples to identify sets of genes and c-miRNA whose quantified expression is related to ventilatory asynchronies and cognitive and emotional impairment in critically ill COVID-19 patients. |
Countries
Spain
Outcome results
None listed