Multiparametric optical technique for fluid resuscitation and vasopressor therapy guidance in critically ill COVID01-19 patients

The global spread of different SARS-CoV-2 variants has caused a major public health burden in the world and has reached 200 million cases. Approximately 5% of these develop severe lung damage requiring hospital admission. The global economic crisis is related to the load caused to intensive care units where mortality rate varies between 8-38%. Critically ill COVID-19 patients require aggressive fluid and vasopressor therapy to maintain systemic hemodynamic, however guidance on such therapies have been adopted from septic patient care and is based on monitoring systemic hemodynamic and lactate levels, which is insufficient. This multidisciplinary project aims to develop optical multimodal techniques for guiding fluid resuscitation and vasopressor therapy in intensive care units (ICU) with critically ill COVID-19 patients by monitoring macrohemodynamic and microvascular parameters. A set of therapy guidance recommendations will be developed.

The main goal of the project is to develop a multimodal technique for fluid and vasopressor therapy guidance for COVID-19 patients in ICU. This will be achieved in close collaboration with experts from three different fields: clinicians - frontline COVID-19 ICU experts, experts in cardiovascular physiology, and biophotonics. The project's R&D team has previous experience in developing ICU equipment for risk stratification of septic patients and neuropathic patient diagnostics which raises success of present project.

The proposed technique will include:

• COVID-19 patient examination protocols for multimodal fluid/vasopressor therapy guidance and rules for interpretation of examination results (guidelines will be developed by clinicians).
• Prototype - demonstrator of IPPG/CRT technology, for microcirculation assessment and acquisition of perfusion signal with subsequent skin microcirculation spatial mapping which will be computed using real-time data analyses software (developed by physicists).

Clinical protocols and guidelines will be developed in order to provide a comprehensive interpretation of multi-modal data (four aforementioned modalities). This task requires high level of experience of COVID-19 patient management at ICUs, therefore will be provided by our team lead by ICU clinicians. The guidelines will comprise recommendations for decision-making on whether patients are fluid responsive, and already applied amount of fluid is sufficient for optimal resuscitation and targeted goal – normalised arterial pressure and insure adequate organ micro perfusion, in parallel minimising risk of peripheral hypoperfusion, with subsequent ischemia due to administration of vasopressors considering length of ICU stay.