Acute Respiratory Distress Syndrome (ARDS) reflects the hallmark of the critical courseof coronavirus (COVID19). The investigators have recently shown that Exhaled BreathParticles (EBP) measured as particle flow rate (PFR) from the airways could be used as anoninvasive real-time early detection method for primary graft dysfunction (which bears apathophysiological resemblance to ARDS) in lung transplant patients. The investigatorshave also previously demonstrated the utility of PFR in early detection and monitoring ofARDS in a large animal model. PFR has been shown to be elevated prior to the cytokinestorm which classically occurs in ARDS. Early detection of ALI and ARDS is intimatelylinked to a patient's chance of survival as early treatment consisting of the preparationfor intensive care, prone positioning and protective mechanical ventilation can beimplemented early in the process. In the present study the investigators aim to usereal-time PFR as an early detector for COVID19-induced ARDS. The investigators will alsocollect EBPs onto a membrane for subsequent molecular analysis. Previous studies haveshown that most of those proteins found in bronchoalveolar lavage (BAL) can also bedetected in EBPs deposited on membranes. The investigators therefore also aim to be ableto diagnose COVID19 by analyzing EBPs using Polymerase Chain Reaction (PCR) with the samespecificity as PCR from BAL, with the added benefit of being able to identify proteinbiomarkers for early detection of ARDS.
EBP will be measured on 100 patients who are coronavirus (COVID-19) positive as indicated
by PCR tests. Measurement will be done on daily basis from the time the patient is
admitted to the hospital as an inpatient until either discharge or transition to ICU
care. The initiation of mechanical ventilation in ICU patients will facilitate the
tracking of EBP patterns over the course of disease in each patient. EBP measurements
will also be done on 100 patients without COVID19 infection who have normal lung function
as a control cohort.
The study will involve measurements on patients who have been placed on mechanical
ventilation in the ICU. The purpose of utilizing PFR will be to reduce the need for
invasive diagnostic tests such as bronchoscopy and for hospital transportation associated
with tests such as CT scans. This will ultimately serve to not only decrease the risk of
infecting other patients and staff in the hospital environment, but also to facilitate
careful monitoring of these critical patients by measuring the extent of lung injury over
time. In addition to PFR, EBP will be collected and measured on a daily basis to track
the EBP patterns on patients in mechanical ventilation. Pre-clinical studies have shown
that EBP can measure the extent of lung injury over time (onset of ARDS and recovery
(unpublished data))
Measurements are also planned for patients who are on mechanical ventilation on
extracorporeal membrane oxygenation (ECMO) support as well.
Inclusion Criteria:
- Clinical diagnosis of ALI
- Clinical diagnosis of ARDS
- COVID-19 infection as measured by a positive PCR test
Exclusion Criteria:
- Dementia
- Severe neurological disease
- Drug abuse
Region Skåne
Lund, Skåne Län, Sweden
Investigator: Sandra Lindstedt Ingemansson, MD, PhD
Contact: 0737220580
sandra.lindstedt_ingemansson@med.lu.se
Sandra Lindstedt Ingemansson, MD, PhD
+46737220580
sandra.lindstedt_ingemansson@med.lu.se
Leif Pierre, PhD
+467073096605
leif.pierre@skane.se
Sandra Lindstedt Ingemansson, MD, PhD, Principal Investigator
Region Skåne, Lund University