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Effects of COVID-19 Infection and Critical Illness on Diaphragm Tissue Characteristics and Movement, Visualized With MRI

2021年3月17日 更新者：Prof.dr. L.M.A. Heunks、Amsterdam UMC, location VUmc

Effects of COVID-19-infection and Mechanical Ventilation on Movement and Tissue Characteristics of the Diaphragm, Visualized by Magnetic Resonance Imaging: a Proof-of-concept Study

COVID-19-infection has a large impact on the respiratory system and possibly on the diaphragm, the main respiratory muscle. In ICU-patients, diaphragm weakness is associated with prolonged ICU-stay, difficult weaning and increased mortality. Our research group recently found evidence for fibrosis and expression of genes involved in fibrosis as well as viral infiltration of the SARS-CoV-2 virus in diaphragm biopsies from COVID-19 ICU patients. This finding suggests a unique manifestation of diaphragm injury in COVID-19 patients after mechanical ventilation. However, it remains unclear what the exact nature and location of diaphragm injury is.

Additionally, it is largely unknown whether this injury affects the movement of the diaphragm, but this might have important clinical implications. Therefore, we aim at visualizing the tissue characteristics and movement of the diaphragm in COVID-19 patients who recently received long-term mechanical ventilation, other ICU patients and healthy controls, using magnetic resonance imaging (MRI). MRI of the diaphragm was already shown feasible in previous research from our group (article currently under review).

New insights in the characteristics of diaphragm weakness and injury in COVID-19 patients and control ICU-patients will contribute to strategies to prevent it and monitor the diaphragm of patients under mechanical ventilation, which can contribute to better patient outcomes.

研究概览

地位

未知

条件

干预/治疗

研究类型

观察性的

注册 (预期的)

40

联系人和位置

本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。

学习地点

  • 荷兰
    • Noord-Holland
      • Amsterdam、Noord-Holland、荷兰、1081HV
        • 招聘中
        • Amsterdam UMC, location VUmc
        • 接触：
        • 副研究员：
          • Myrte Wennen, MSc
        • 首席研究员：
          • Leo Heunks, Prof. Dr.

参与标准

研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。

资格标准

适合学习的年龄

18年 及以上 (成人、年长者)

接受健康志愿者

是的

有资格学习的性别

全部

取样方法

非概率样本

研究人群

Patients that were recently (<= 7 days ago) discharged from the ICU and received mechanical ventilation form the study population with a specific sub group of COVID-19 patients. Healthy, age and gender matched volunteers are selected as control group.

描述

Inclusion criteria

In order to be eligible to participate in this study, a subject in the case group must meet all of the following criteria:

  • Invasive mechanical ventilation > 72 hours during current hospital admission
  • Admitted for COVID-19-infection (n = 10)
  • Currently negative COVID-19 PCR test
  • Discharged from the ICU ≤ 7 days ago
  • Signed informed consent
  • Age ≥ 18 years

In order to be eligible to participate in this study, a subject in the control group must meet all of the following criteria:

  • Signed informed consent
  • Age ≥ 18 years
  • Similar age (max 5 years difference) and gender of one of the subjects in case group

Exclusion criteria

A potential subject for the case group who meets any of the following criteria will be excluded from participation in this study:

  • Known history of:

    • Diaphragmatic injury or weakness prior to ICU stay
    • COPD (GOLD IV)
    • Neuromuscular disease (including pathology of the n. phrenicus)
    • Connective tissue disease
    • Chronic use of corticosteroids (>7.5 mg/day for at least 3 months before hospital admission)
    • >10% weight loss within last 6 months prior to ICU admission
  • Obesity (BMI > 30 kg/m2 at hospital admission)
  • Known pregnancy

  • Contraindications for MRI

    • Electrical/metallic implants
    • Claustrophobia
  • Unable to hold breath for 10 seconds
  • Hierarchical relation with one of the collaborating investigators
  • Incapacitation

  • Contraindications for the use of a Gadolinium based contrast agent for MRI

    • Known eGFR < 30 ml/min/1.73m2
    • Known history of allergic reactions to an MRI contrast medium
    • Known history of allergic reactions requiring immediate treatment
    • Known history of atopy
    • Asthma These exclusion criteria are based on the guidelines for contrast agents from the European Society for Urogenital Radiology (http://www.esur.org/guidelines/).

Additional exclusion criteria for the case group, subset non-infected patients are:

• History of COVID-19-infection (confirmed with positive test)

Additional exclusion criteria for the control group are:

  • History of mechanical ventilation > 24 hours
  • History of COVID-19-infection (confirmed with positive test)

学习计划

本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。

研究是如何设计的？

设计细节

队列和干预

团体/队列
干预/治疗
Healthy volunteers
Healthy volunteers, matched by age and gender to patient groups.
其他：Contrast-enhanced MRI
Contrast-enhanced MRI
其他：Measurement of respiratory muscle force
Measurement of the maximum inspiratory and expiratory pressure.
COVID-19 patients
Patients discharged from the ICU after invasive ventilation for COVID-19.
其他：Contrast-enhanced MRI
Contrast-enhanced MRI
其他：Measurement of respiratory muscle force
Measurement of the maximum inspiratory and expiratory pressure.
ICU patients
Patients discharged from the ICU after invasive ventilation for ARDS.
其他：Contrast-enhanced MRI
Contrast-enhanced MRI
其他：Measurement of respiratory muscle force
Measurement of the maximum inspiratory and expiratory pressure.

研究衡量的是什么？

主要结果指标

结果测量
措施说明
大体时间
Tissue characteristics of the diaphragm
大体时间：1 hour
Extracted from contrast enhanced imaging
1 hour
Movement of the diaphragm
大体时间：1 hour
Description of the movement of the diaphragm in 4D fashion.
1 hour

次要结果测量

结果测量
措施说明
大体时间
Quantitative dynamic contrast enhanced imaging of the diaphragm
大体时间：1 hour
Application of modelling to describe tissue characteristics of the diaphragm using contrast inflow.
1 hour
Correlation of movement and tissue characteristics of the diaphragm with measurements of maximum inspiratory and expiratory pressure
大体时间：1 hour
1 hour
Correlation of movement and tissue characteristics of the diaphragm with clinical parameters
大体时间：1 hour
Clinical parameters include ventilator settings, biomarkers for inflammation (CRP, white blood cell count) during ICU admission, daily dosage of drugs known with adverse effects on respiratory muscles, fluid balance, protein intake, primary reason for ICU admission and weaning duration.
1 hour

其他结果措施

结果测量
大体时间
Correlation of diaphragm tissue characteristics with tissue characteristics of the abdominal muscles
大体时间：1 hour
1 hour

合作者和调查者

在这里您可以找到参与这项研究的人员和组织。

赞助

Amsterdam UMC, location VUmc

研究记录日期

这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。

研究主要日期

学习开始 (实际的)

2021年2月3日

初级完成 (预期的)

2023年1月19日

研究完成 (预期的)

2023年1月19日

研究注册日期

首次提交

2021年1月14日

首先提交符合 QC 标准的

2021年2月2日

首次发布 (实际的)

2021年2月3日

研究记录更新

最后更新发布 (实际的)

2021年3月18日

上次提交的符合 QC 标准的更新

2021年3月17日

最后验证

2021年3月1日

更多信息

与本研究相关的术语

关键字

其他相关的 MeSH 术语

其他研究编号

  • NL 72271.029.19

计划个人参与者数据 (IPD)

计划共享个人参与者数据 (IPD)？

未定

药物和器械信息、研究文件

研究美国 FDA 监管的药品

不

研究美国 FDA 监管的设备产品

不

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