Identifying the Immune Basis for Respiratory Failure in COVID-19

Medical Context Acute respiratory distress syndrome (ARDS) is a potentially deadly complication of COVID-19 infection. It is characterized by inflammatory injury to the delicate air sacs (alveoli) and microscopic blood vessels within the lungs and profound oxygen deprivation that leads to end-organ damage and death. The observed course of ARDS triggered by COVID-19 infection, compared to other triggers such as bacterial pneumonia or non-pulmonary sepsis, suggests that COVID-19 ARDS is a unique clinical entity. The immune cells that drive this response remain almost completely unknown, and the standard technique for collecting them from the lung airspaces of affected patients-fiberoptic bronchial lavage-poses a significant danger to healthcare providers due to the risk of creating infectious aerosols during the procedure. Research Proposal Dr. Mould's group has previously demonstrated the efficacy of a safer technique for sampling cells and fluids from infected lungs, called non-bronchoscopic lavage, or "mini-BAL." This minimally invasive technique uses a closed system that prevents the release of aerosols and that can be safely used to perform serial lavages throughout a patient's course in the ICU. Dr. Mould will leverage the mini-BAL technique to collect samples from patients with COVID‑19 ARDS as well as those with non-COVID ARDS, in order to construct a time course of inflammatory responses. She will then correlate them with presence of leukocytes and inflammatory mediators in the circulating blood. This study will provide the first-ever, time-resolved assessment of inflammatory responses in COVID-19 and non-COVID ARDS.