The purpose of this study is to determine the effects of Almitrine administration on oxygenation in COVID-19 patients with acute respiratory distress syndrome treated by high-flow nasal canula oxygen therapy as first-line ventilatory support.
From December 2019, the emergent coronavirus SARSCoV-2 is responsible for the worldwide pandemic of coronavirus disease (COVID-19). Although SARSCoV-2 infection is mainly responsible for mild respiratory symptoms, up to 70% of hospitalized patients with COVID-19-related pneumoniae may develop severe respiratory disease, progressing to acute respiratory distress syndrome (ARDS). These patients may experience severe but well-tolerated hypoxemia, so-called "happy hypoxemia" which may be related to blunted hypoxic vasoconstriction. Almitrine is a selective pulmonary vasoconstrictor that has been reported to improve the oxygenation in ARDS patients by increasing hypoxic pulmonary vasoconstriction. Some small case series reported that the use of Almitrine in mechanically ventilated COVID-19 patients with ARDS improved oxygenation. Given the "happy hypoxemia" phenomenon, it has been suggested to use high-flow nasal canula therapy (HFNO) as first-line ventilatory support in COVID-19 patients with ARDS, since the risk of aerosolization with HFNO was similar to that with standard oxygen therapy and lower to that with non-invasive ventilation. However, the effects of Almitrine in spontaneously breathing patients with ARDS has not been reported so far. Thus, the main goal of this study is to investigate the effects of Almitrine on oxygenation of COVID-19 patients with ARDS treated by HFNO as first-line ventilatory support. The second goal of this study is to determine the effects of Almitrine on respiratory mechanics and hymodynamics.
Study Type
OBSERVATIONAL
Enrollment
62
Administration of Almitrine (intravenous bolus of 0.5 mg/kg over 30 minutes followed by a continuous perfusion of 16 mg/kg/min in responders)
CHU de NICE
Nice, France
Almitrine-induced increase in Pa02/FiO2 ratio.
The PaO2/FiO2 ratio will be calculated before and after the bolus of Almitrine. Patients with increase in PaO2/FiO2 ratio \> 20% will be considered as responders.
Time frame: The 30-minute duration of Almitrine bolus
Proportion of patients requiring intubation
To assess the proportion of patients who will require to be intubated during their ICU stay.
Time frame: ICU stay
Proportion of patients exhibiting right ventricular failure and/or right ventricular dilation and/or acute core pulmonale after administration of Almitrine.
To assess the proportion of patients who will experience right ventricular failure and/or right ventricular dilation and/or acute core pulmonale after administration of Almitrine.
Time frame: The 30-minute duration of Almitrine bolus
Clinical prediction of Almitrine effects
To test the ability of different respiratory variables and radiological patterns to predict the response to Almitrine in terms of oxygenation
Time frame: The 30-minute duration of Almitrine bolus
Radiological prediction of Almitrine effects
To test the ability of different radiological patterns to predict the response to Almitrine in terms of oxygenation
Time frame: The 30-minute duration of Almitrine bolus
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.