Patients with severe acute respiratory syndrome due to Covid-19 in an Emergency Department

The current Covid-19 pandemic has affected more than 920,000 people and killed more than 46,000 worldwide. Most affected patients have a mild condition, but a small percentage, from the percentage point of view, but large in absolute numbers, may have a severe acute respiratory syndrome (SARS), with fever, cough, pulmonary infiltrates and hypoxemia, and may progress for respiratory failure and need for mechanical ventilation. The Emergency Service of Hospital das Clínicas, Faculty of Medicine, University of São Paulo (HCFMUSP) is the current reference center for the treatment of patients with the most severe form of the disease. Our team is responsible for the initial care of these patients and, therefore, is well positioned to produce the necessary knowledge for a better understanding and treatment of this disease. In this way, we created this project, which consists of four subprojects. The first subproject aims to determine whether serum markers of the inflammatory response can predict, alone or in combination, the evolution of patients with SARS by Covid-19 for respiratory failure. The second seeks to determine whether pulmonary ultrasound is a viable alternative for assessing respiratory function in these patients. The third is a clinical trial with a drug already used in other clinical situations and which may be useful in preventing respiratory failure in patients with Covid-19 pneumonia. Finally, the fourth focuses on statistical and stochastic models, which can improve and guide the care of these patients. The study will be conducted at the Emergency Service of HCFMUSP, which is the gateway to the vast majority of patients with SARS by Covid-19. Patients with severe acute respiratory syndrome who do not require mechanical ventilation at admission will be included. In subprojects 1 and 2, these patients will only be followed up, without intervention, performing laboratory and ultrasound exams. In subproject 3, patients will be divided into two groups, one receiving NAC and the other placebo. In all three subprojects, the outcome will be mortality and the need for mechanical ventilation. In this pandemic moment, the search for a better understanding of the disease and treatments that can reduce the need for mechanical ventilation in these patients is extremely urgent and these are exactly the objectives of our project.