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Acute Lung Injury clinical trials

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NCT ID: NCT05198986 Not yet recruiting - Clinical trials for Acute Respiratory Distress Syndrome

Pronation During Veno-venous Extra Corporeal Membrane Oxygenation

Start date: February 1, 2022
Study type: Observational

The Acute Respiratory Distress Syndrome (ARDS) is defined by a recent (within 1 week) respiratory failure, not fully explained by cardiac failure or fluid overload. ARDS is also characterized by bilateral opacities at the chest imaging, with an alteration of the oxygenation while positive end-expiratory pressure equal or greater than 5 cmH2O is applied. Severe ARDS is characterized by a high mortality. In the most severe ARDS patients, venovenous extracorporeal membrane oxygenation (vv-ECMO) is increasingly accepted as a mean to support vital function, although not free from complications. In patients with severe ARDS, prone position has been used for many years to improve oxygenation. In these patients, early application of prolonged (16 hours) prone-positioning sessions significantly decreased 28-day and 90-day mortality. More recently, prone position and ECMO have been coupled as concurrent treatment. Indeed, the addition of prone positioning therapy concurrently with ECMO can aid in optimizing alveolar recruitment, and reducing ventilator-induced lung injury. Nowadays, few data exist on respiratory mechanics modifications before and after the application of prone position in patients with severe ARDS receiving vv-ECMO. The investigators have therefore designed this observational study to assess the modifications of mechanical properties of the respiratory system, ventilation and aeration distribution, and hemodynamics occurring during ECMO before and after prone position in patients with severe ARDS.

NCT ID: NCT05193526 Recruiting - Clinical trials for Acute Respiratory Distress Syndrome Related to SARS-CoV-2

COronaVirus Induced Acute Respiratory Disease Syndrome During PREGnancy

Start date: November 15, 2021
Study type: Observational

Few data are available on the management of critically ill pregnant women with pneumonia related to SARS-CoV-2. In the absence of clear recommendations for the management of delivery, clinicians are faced with the risk of pregnancy continuation against the risk of premature birth. In these multicenter retrospective study, we want to describe clinicians attitude on delivery management in pregnant women requiring invasive mechanical ventilation for acute respiratory distress syndrome related to SARS-CoV-2. Two strategies will be compared on maternal, obstetric and neonatal outcomes: - Wait strategy defined by no extraction within 24 hours of invasive venting - Early strategy defined by extraction within 24 hours of invasive ventin

NCT ID: NCT05191433 Recruiting - Clinical trials for COVID-19 Acute Respiratory Distress Syndrome

Effects of Mechanical Ventilation on the Diaphragm in COVID-19 Intensive Care Patients. A Post-mortem Pathology Study

Start date: November 1, 2020
Study type: Observational

The diaphragm is the fundamental muscle of the respiratory system. The diaphragmatic dysfunction is present in 60% of critical patients at hospital admission and up to 80% after prolonged mechanical ventilation and difficult weaning. Risk factors associated with diaphragm dysfunction and atrophy are sepsis, trauma, sedatives, steroids, and muscle relaxants. The main pathology characteristics of diaphragm biopsies of mechanically ventilated patients are atrophy and a reduction in contractility, determining an impact on the clinical outcome. Shi et al. found a higher section area of the diaphragm muscle fiber in biopsies of post mortem COVID-19 patients versus negative patients, independently from days of mechanical ventilation. The hypothesis of our study is to identify different clusters of pathological presentation in post-mortem COVID-19 mechanically ventilated patients.

NCT ID: NCT05180409 Recruiting - Clinical trials for Acute Respiratory Distress Syndrome

Assessment of Microcirculation Alteration With Both Sublingual Microcirculation and Near-infrared Spectroscopy on ARDS

Start date: December 1, 2020
Study type: Observational

Microcirculatory alterations are frequently observed in critically ill and severe sepsis patients characterized by a decrease in capillary density and an increase in heterogeneity of perfusion. This derangements result in microcirculatory shunting and oxygen extraction deficit, and plays a major role in the pathophysiology of sepsis and multi-organ failure. Loss of hemodynamic coherence between the macro- and microcirculation results in persistent and incomplete reversal of microcirculatory and regional hypoxia that is the major factor contributing to the development of organ failure. Current techniques permitting monitoring the microcirculation can be classified in two main groups: (1) Methods for evaluation of local tissue oxygenation as a surrogate of microcirculatory blood flow. (2)Methods allowing direct visualization of the microvascular network and microcirculatory blood flow. Near-infrared spectroscopy (NIRS) is a non-invasive technique for evaluating tissue oxygenation in vessels with a diameter < 1 mm (arterioles, capillaries, and venules). Recent systemic review studies have showed that patients with severe sepsis or septic shock have lower levels of StO2, moreover, survivors present higher levels of StO2 compared with non-survivors. Reactive hyperemia during vascular occlusion test (VOT) can be considered an integral test of microcirculatory reactivity, evaluating the tissue's ability to adjust oxygen extraction capabilities to oxygen delivery after a hypoxic stimulus induced by a transient interruption in blood flow. Continuous StO2 measurement and VOT derived StO2 deoxygenation slope and StO2 recovery slope have been found to be predictors of mortality and organ dysfunction. Sublingual microcirculation allows direct visualization of the sublingual microcirculation and for quantitative determination of variables of flow, capillary density, and flow distribution. Microvascular alterations including decreased functional capillary density, increased perfusion heterogeneity, and increased proportion of stopped and intermittently perfused capillaries, are more severe in non-survivors than in survivors. In addition, persistence of these alterations was strongly and independently correlated with multi-organ failure and mortality. ARDS is the most severe form of acute lung injury in ICU with mortality about 45% without achievement in ten years. However, only few studies were focused on the microcirculatory alterations in ARDS patients.

NCT ID: NCT05178199 Not yet recruiting - Clinical trials for COVID-19 Acute Respiratory Distress Syndrome

The Effectiveness of RPSG Intervention for Nurses During the COVID-19

Start date: January 2022
Phase: N/A
Study type: Interventional

The cases of COVID-19 are continuing to be confirmed around the world. In the clinical settings, the nurses in evacuation acute wards are main responsibility to undertake the care of emergency patient follow-up and suspected or confirmed COVID-19 cases. Those nurses have to face the high psychological pressure, unknown panic, fear and so on. Thus, the study plans to invite nurses who are working in evacuation acute wards to participate the project called "Remote Psychological Support Group (RPSG)". The study supposes "RPSG" could improve nurses' self-efficacy, fear of COVID-19, psychological distress, and quality of life.

NCT ID: NCT05178160 Completed - Clinical trials for COVID-19 Acute Respiratory Distress Syndrome

Positive End Espiratory Pressure Trial in Coronavirus Disease 19 Treated With Continuous Positive Airway Pressure

Start date: January 1, 2021
Phase: N/A
Study type: Interventional

Consecutive patients with hypoxemic respiratory failure, CT evidence of bilateral pneumonia and diagnosis of Coronavirus Disease 19 (COVID-19) with molecular nasopharyngeal swab consecutively admitted to the COVID Care Unit of the "Santa Maria delle Grazie" Hospital were enrolled. All the patients with clinical indication for Continuous Positive Airway Pressure (CPAP) were randomized 1:1 into two groups: Group A received a fixed Positive End Expiratory Pressure (PEEP) of 10 centimetre of water (cmH2O), Group B underwent the PEEP trial to identify the optimal PEEP (defined as the highest value that preceded the appearance of the "lung pulse" at lung ultrasound and that determined an increase in PaO2/FiO2 by at least 20%). Primary endpoint was defined as a composite in-hospital mortality+intubation, secondary endpoint was the improvement of PaO2/FiO2. As safety indicator, the incidence of pneumothorax was collected.

NCT ID: NCT05166915 Recruiting - Clinical trials for Acute Respiratory Distress Syndrome

Respiratory COVID-19: A Randomized, Sham-Controlled Study

Start date: December 2021
Phase: N/A
Study type: Interventional

A study of intubated critically ill patients infected with SARS-COV-2 to evaluate the safety and treatment effects of ultraviolet-A (UVA) light administered by a novel device via endotracheal tube in a first-in-human study. Study hypothesis was that respiratory SARS-CoV-2 viral burden would significantly decrease following five (5) days of UVA therapy.

NCT ID: NCT05164744 Recruiting - COVID-19 Clinical Trials

Cardiac Magnetic Resonance Tissue Characterization in COVID-19 Survivors

Start date: July 1, 2021
Study type: Observational

The purpose of this study is to test if visualizing the heart with cardiac MRI/echo will be important in the understanding cardiac function and prediction of cardiopulmonary symptoms, physical effort tolerance, and outcomes in COVID-19 survivors. If successful, the research will allow us to identify the causes of lasting cardiopulmonary symptoms and begin developing cardiac and lung directed therapies accordingly.

NCT ID: NCT05164484 Not yet recruiting - Clinical trials for Acute Respiratory Distress Syndrome

Assessment of Cardiac Output in Patients With ARDS Implanted With Venous-venous ECMO.

Start date: December 15, 2021
Phase: N/A
Study type: Interventional

In patients with severe acute respiratory distress syndrome, extracorporeal membrane oxygenation (ECMO), which also as known as extracorporeal life support, may be used. This technique helps the lungs by providing oxygenation to the blood via an external gas exchanger and thus participates partially or fully in gas exchange. The ECMO device includes a pump for draining and returning blood at a certain blood flow rate (ECMO blood flow). An ECMO rate that is adapted to the patient's cardiac output (CO) is essential for effective oxygenation for patients. The objective for clinicians is an ECMO blood flow to cardiac output ≥40%, which can go up to 100% as needed. In addition to the expected benefit in the management of the patient with ARDS, measuring CO is, therefore, all the more important in patients requiring ECMO. Monitoring CO in a patient with ECMO is not only for determining the minimum ECMO blood flow rate but also for optimizing the functioning of the ECMO. However, the validity of techniques for measuring CO in patients with ECMO has been poorly studied. The reliability of the CO measurement by transpulmonary thermodilution is questioned since the extracorporeal circulation may influence the pathway of cold indicator injected into the patients' circulation and the thermodilution curve measured from the femoral arterial is thereby modified.

NCT ID: NCT05162508 Recruiting - SARS-CoV2 Infection Clinical Trials

Impact of COVID-19 SARS-CoV-2 Variability in ICU Hospitalized Patients With Severe Disease

Start date: December 16, 2021
Study type: Observational

Background:The impact of the emergence of SARS-CoV-2 variants on the severity and clinical outcomes of COVID-19 is controversial. Whether virological characteristics including the mutational patterns of the different viral proteins (e.g., Spike, NSP proteins, ORF6) could be associated with a different immune response and subsequent severity of the disease is unknown. ln the next coming months, new variants carrying the same or new mutational patterns will continue to emerge. Monitoring their dynamics over time and their impact on disease severity is required for refining national and international disease control policies. Main objective: To unravel the relationships between specific viral mutations/mutational patterns and the clinical outcomes of COVID-19 in patients hospitalized in intensive care units (ICUs) for acute respiratory failure following severe SARS-CoV-2 infection. Design of the study Prospective multicentre observational cohort study Schedule for the study: Inclusion period: 24 months; Participation period: 28 days ; Total duration : 24 months + 28 days;