Official Title
Inhaled Sedation in COVID-19-related Acute Respiratory Distress Syndrome (ISCA): an International Research Data Study in the Recent Context of Widespread Disease Resulting From the 2019 (SARS-CoV2) Coronavirus Pandemics (COVID-19)
Brief Summary

The authors hypothesized that inhaled sedation, either with isoflurane or sevoflurane, might be associated with improved clinical outcomes in patients with COVID-19-related ARDS, compared to intravenous sedation. The authors therefore designed the "Inhaled Sedation for COVID-19-related ARDS" (ISCA) non-interventional, observational, multicenter study of data collected from the patients' medical records in order to: 1. assess the efficacy of inhaled sedation in improving a composite outcome of mortality and time off the ventilator at 28 days in patients with COVID-19-related ARDS, in comparison to a control group receiving intravenous sedation (primary objective), 2. investigate the effects of inhaled sedation, compared to intravenous sedation, on lung function as assessed by gas exchange and physiologic measures in patients with COVID-19-related ARDS (secondary objective), 3. report sedation practice patterns in critically ill patients during the COVID-19 pandemics (secondary objective).

Detailed Description

The acute respiratory distress syndrome (ARDS) is the most severe and lethal complication of
COVID-19, and healthcare resource utilizations are currently being heavily challenged in most
countries worldwide, with a high risk that some intensive care resources, such as the number
of ventilators to allow management all patients, may be insufficient to face the current
surge in ARDS cases. There is, therefore, an urgent need to evaluate candidate therapies that
may impact clinical outcomes in patients with COVID-19-related ARDS and potentially be
relevant to current public health issues, in accordance with the international efforts by the
World Health Organization (WHO) (Global research on coronavirus disease) and most
international public health organizations. Beyond the current efforts to find specific
antiviral therapies or vaccines, improving supportive care and treatment options for patients
with COVID-19-related ARDS, in accordance with up-to-date guidelines on the management of
critically ill patients with COVID-19 (Surviving Sepsis Campaign: Guidelines on the
Management of Critically Ill Adults with Coronavirus Disease 2019; The Australian and New
Zealand Intensive Care Society (ANZICS) COVID-19 Guidelines; Recommandations d'experts
SRLF-SFAR-SFMU-GFRUP-SPILF sur la prise en charge en réanimation des patients en période
d'épidémie à SARS-CoV2), is of major importance.

Indeed, given the number of intensive care unit (ICU) patients for whom the question of
sedation applies during the current COVID-19 outbreak, any sedation practice that would be
associated with improved clinical outcomes could have significant economic and public health
implications. In this perspective, the rationale supporting inhaled sedation with halogenated
agents (such as isoflurane or sevoflurane) as a way to improve lung function, to decrease the
inflammatory response, and to possibly improve patient outcome is strong.

The authors hypothesized that inhaled sedation, either with isoflurane or sevoflurane, might
be associated with improved clinical outcomes in patients with COVID-19-related ARDS,
compared to intravenous sedation. The authors, therefore, designed the "Inhaled Sedation for
COVID-19-related ARDS" (ISCA) non-interventional, observational, multicenter study of data
collected from the patients' medical records in order to :

1. assess the efficacy of inhaled sedation in improving a composite outcome of mortality
and time off the ventilator at 28 days in patients with COVID-19-related ARDS, in
comparison to a control group receiving intravenous sedation (primary objective),

2. investigate the effects of inhaled sedation, compared to intravenous sedation, on lung
function as assessed by gas exchange and physiologic measures in patients with
COVID-19-related ARDS (secondary objective),

3. report sedation practice patterns in critically ill patients during the COVID-19
pandemics (secondary objective).

This study will be performed in accordance with the Strengthening the Reporting of
Observational studies in Epidemiology (STROBE) statement.

Completed
Critically Illness
Sedation
Invasive Mechanical Ventilation
Acute Respiratory Distress Syndrome

Drug: Intravenous sedation

Patients will be included retrospectively in the study by local investigators at each participating center. As this is a non-interventional study, sedation practices will be those currently used as standard practices in participating centers, including both intravenous and inhaled sedation practices

Drug: Inhaled sedation

Patients will be included retrospectively in the study by local investigators at each participating center. As this is a non-interventional study, sedation practices will be those currently used as standard practices in participating centers, including both intravenous and inhaled sedation practices

Eligibility Criteria

Inclusion Criteria:

- Adult patients (18 years old),

- Admitted to a participating ICU (or any other ICU-like setting that may be deployed as
a result of the COVID-19 pandemics, such as in the operating room, post-anesthesia
care unit, step-down unit or any COVID-19-specific unit set in response to the
pandemics in a participating center),

- Requiring invasive mechanical ventilation,

- With suspected or confirmed COVID-19 on day 0.

Exclusion Criteria:

- None

Eligibility Gender
All
Eligibility Age
Minimum: 18 Years ~ Maximum: N/A
Countries
France
Germany
Spain
Switzerland
United States
Locations

Beth Israel Deaconess Medical Center, Inc.
Boston, Massachusetts, United States

CHU
Brest, France

CHU
Clermont-Ferrand, France

Centre Hospitalier
Dunkerque, France

Pitié-Salpêtrière Hospital - APHP
Paris, France

CH Privé de la Loire
Saint-Étienne, France

Universitätsklinikum
Bochum, Germany

University Medical Center Schleswig-Holstein
Kiel, Germany

Universitätsklinikum
Oldenburg, Germany

Hospital Clínico Universitario de Valencia
Valencia, Spain

Cantonal Hospital
Münsterlingen, Switzerland

Universitätsspital
Zürich, Switzerland

Matthieu Jabaudon, Study Chair
University Hospital, Clermont-Ferrand

University Hospital, Clermont-Ferrand
NCT Number
Keywords
Mechanical Ventilation
Acute Respiratory Distress Syndrome
Inhaled sedation
Intravenous sedation
Covid-19
MeSH Terms
COVID-19
Respiratory Distress Syndrome
Respiratory Distress Syndrome, Newborn
Acute Lung Injury
Syndrome