A Respiratory infection with the SARS-CoV2 virus is associated with a major risk of viral pneumonia that can lead to respiratory distress requiring resuscitation. In the most severe forms, it may require mechanical ventilation or even lead to an acute respiratory distress syndrome with a particularly poor prognosis. The SARS-CoV2 is a single-stranded RNA virus of positive polarity and belongs to the beta genus of Coronaviruses. SARS-CoV2 is responsible for the third epidemic in less than twenty years secondary to a Coronavirus (SARS-CoV then MERS-CoV) and if the mortality associated with it is lower than that of previous strains, notably MERS-CoV, its spread is considerably big. As a result, the number of patients developing respiratory distress requiring invasive mechanical ventilation is high, with prolonged ventilation duration in these situations
Patients requiring invasive mechanical ventilation are at risk of secondary, nosocomial, a
hospitalization in the ICU service and can affect up to 40% of ventilated patients. The
occurrence of ventilator-associated pneumonia is associated with an increase in the duration
of mechanical ventilation and its effect on mortality remains uncertain under general
conditions. The mechanisms underlying the occurrence of lower respiratory infection during
invasive mechanical ventilation are numerous, depending for the most part on two distinct
elements: the occurrence of transcolonisation, which will secondarily promote colonisation of
the lower respiratory tract, and the modification of the competence of the immune system in
its response to aggression by microbial agents whose pathogenicity is highly variable.
Throughout the infection by SARS-CoV2, the theoretical risk of secondary respiratory
infection during mechanical ventilation is important due to the intrication of three
concomitant phenomena: direct pulmonary aggression, which will alter the functionality of
local immunity, the "cytokinic storm", responsible for the severity of the respiratory
picture that motivated intubation and the need for mechanical ventilation leading inevitably
to transcolonisation. Despite all of these pathophysiological arguments, very little data are
available on the possibility of secondary low respiratory tract infection occurring during
SARS-CoV2 infection and more generally during Coronarivus infections. even though all of
these elements are well known and widely studied, very little data are currently available on
the potential interaction between Coronaviruses and bacteria. The importance of this issue is
very significant as recent observations tend to show a relative rarity of the occurrence of
secondary lung infections during mechanical ventilation and the population of smokers,
subject to chronic obstructive bronchitis (usually particularly susceptible to bacterial
superinfections), does not appear to be more affected than that of non-smokers although the
current data are very partial.
The research is prospective, non interventional study that involves patients suffering from
another severe form a COVID-19 infection: the nosocomial pneumonia under mechanical
ventilation
Inclusion Criteria:
- Patient whose age ≥ 18 years old
- French-speaking patient
- Patient whose COVID-19 infection was diagnosed by either a laboratory test, PCR or any
other commercial or public health test.
- Adult acute respiratory distress syndrome according to the Berlin definition
- Pneumonia acquired under mechanical ventilation defined according to the criteria of
international companies
Exclusion Criteria:
- Patient/family or proxy opposing participation in the study
- Patient under guardianship or curatorship
- Patient deprived of liberty
- Patient under the safeguard of justice.
Groupe Hospitalier Paris Saint-Joseph
Paris, France
François PHILLIPART, MD, Principal Investigator
Groupe Hospitalier Paris Saint Joseph