Cardiac Dysfunction in Critically Ill Covid-19 Patients

N/ACompletedNCT06197256

Region Stockholm39 enrolled

Overview

We conducted an observation sub-study of the prospective randomized controlled trial "High Dose Inhaled Nitric Oxide in Acute Hypoxemic Respiratory Failure", in which we analysed the echocardiographic data collected both at baseline when patients where included and 3-5 days later for followup.

We conducted an observation sub-study of the prospective randomized controlled trial "High Dose Inhaled Nitric Oxide in Acute Hypoxemic Respiratory Failure" which was conducted in 2020/2021 during the COVID-19 pandemic on patients with ARDS due to COVID and requiring mechanical ventialtion. Patients underwent echocardiography at baseline, and were then randomized either to control, or treatment with inhaled nitric oxide, starting at 80ppm and then 40ppm. Followup echocardiography was performed 3-5 days later, and all echocardiographies were conducted by highly experienced sonographeres certified by the European Association of Cardiovascular Imaging. Analysis of these cardiac ultrasounds focused on the amount of patients showing signs of pulmonary hypertension, right ventricular failure and left ventricular failure. Several parameters were used to estimate these, and we also aimed to evalute the utility of more novel measures such as RV and LV GLS for this use in the ICU.

Study Type

OBSERVATIONAL

Enrollment

Conditions

COVID-19 ARDS, Human Cardiac Failure Right Ventricular Dysfunction Left Ventricular Dysfunction Pulmonary Hypertension

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age ≥18. * Positive PCR for COVID-19. * Admission to the ICU. * Endotracheal intubation and mechanical ventilation. * Severe hypoxemia, defined by PaO2/FiO2 \< 300 mmHg. * Inclusion in the trial "High Dose Inhaled Nitric Oxide in Acute Hypoxemic Respiratory Failure" Exclusion Criteria: * Endotracheal intubation for \>72h before inclusion. * Do not resuscitate order or other limitation of care. * Known pregnancy. * Cases where the treating physician opposes inclusion due to safety concerns or considerations that renders inclusion unfeasible. * Not having had echocardiography performed during the trial period (exclusion criteria for this sub-study).

Locations (1)

Danderyds Hospital

Stockholm, Sweden

Outcomes

Primary Outcomes

Delta MPAP

Difference in MPAP, measured at baseline and at followup

Time frame: 3-5 days

Delta RV GLS

Difference in RV GLS, measured at baseline and at followup

Time frame: 3-5 days

Delta TAPSE

Difference in TAPSE, measured at baseline and at followup

Time frame: 3-5 days

Secondary Outcomes

Delta EF

Difference in EF, measured at baseline and at followup

Time frame: 3-5 days

Delta CI

Difference in CI, measured at baseline and at followup

Time frame: 3-5 days

Delta LV GLS

Difference in LV GLS, measured at baseline and at followup

Time frame: 3-5 days

Rates of LV failure detected by LV GLS compared to EF

Comparison of the amount of patients with LV failure for LV GLS and for EF, presented at both timepoints

Time frame: Presented both at baseline and followup

Rates of RV failure detected by RV GLS compared to TAPSE

Comparison of the amount of patients with RV failure for RV GLS and for TAPSE, presented at both timepoints

Time frame: Presented both at baseline and followup

Associations between levels of pulmonary hypertension, PEEP, peak pressures, central venous pressures and measurements

Data from ClinicalTrials.gov

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