Managing Endothelial Dysfunction in Critically Ill COVID-19 Patients at LAUMCRH
Covid19, Endothelial Dysfunction
About this trial
This is an interventional treatment trial for Covid19
Eligibility Criteria
Inclusion Criteria:
- Participants must be 18 years of age or older
- Participants must have a PCR confirming COVID 19 status
- Participants must be classified as critical as per the FDA evidence of critical illness, which is defined as respiratory failure requiring at least one of the following: Endotracheal intubation and mechanical ventilation, oxygen delivered by high- flow nasal cannula (heated, humidified, oxygen delivered via reinforced nasal cannula at flow rates > 20 L/min with fraction of delivered oxygen ≥ 0.5), noninvasive positive pressure ventilation, ECMO, or clinical diagnosis of respiratory failure (i.e., clinical need for one of the preceding therapies, but preceding therapies not able to be administered in setting of resource limitation)
- Eligible for or already taking Statin
Exclusion Criteria:
- Patients who are already on statins or Nicorandil.
- Patients labeled as having mild, moderate or severe COVID-19 infection as per the FDA definitions.
- Patients with shock as defined by SBP<90 for more than 30 minutes not responding to IV fluids with evidence of end organ damage.
- Severe hepatic impairment (Child-Pugh class C) or active liver disease are absolute reasons not to be included especially those with unexplained persistent elevations of serum transaminases.
- Pregnancy or breastfeeding
- Hypersensitivity to any of the above-mentioned medications
- On Levodopa.
- Patients on PDE5 inhibitors, Riociguat
- Acute pulmonary edema
- Hypovolemia
- Leber's disease
Sites / Locations
- LAUMCRHRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
Endothelial Dysfunction Protocol
Standard of care
Experimental: Endothelial Dysfunction Protocol Our study will evaluate the impact of the endothelial treatment protocol (atorvastatin(or home statin), nicorandil, l-arginine, folic acid and vitamin B complex) in critically Ill patients already on optimal medical therapy for the treatment of COVID-19 virus. Protocol will be given for a total of 14 days or until discharge from the hospital Patients already on home statin will continue their medication or if the are eligible for statins they will recieve 40 mg tablet to be given PO once daily. Nicorandil Nicorandil 10 mg PO BID for the first 7 days and then if no contraindications escalated to 20 mg PO BID for the remaining 7 days Folic Acid Folic Acid 5 mg po once daily L-Arginine L-Arginine 1 g po TID Vitamin B complex (Becozyme) 1 ampoule IV daily
Standard of Care