Evaluation of the Efficacy of Nicotine Patches in SARS-CoV2 (COVID-19) Infection in Intensive Care Unit Patients

Inclusion Criteria:

1. Patient ≥ 18 years
2. Documented diagnosis of COVID 19 (according to the tests referenced on the listpublished on the website : https://covid-19.sante.gouv.fr.tests)
3. Hospitalized in intensive care unit, intubated and mechanically ventilated for lessthan 48 hours
4. Non-smoker and non-vaping or abstinent patient for at least 12 months
5. Obtain written informed consent from a relative / relative / support person. In theabsence of a close/relative/trusted person, the patient may be included according tothe emergency procedure by the investigating doctor.
6. Affiliated to a social security scheme or beneficiary of such a scheme (AME excluded)

Exclusion Criteria:

1. Chronic respiratory failure defined by PaCO2> 60 mmHg in ambulatory patients (respiratory parameters at baseline).
2. Mechanical ventilation at home (non-invasive mechanical ventilation or via atracheostomy) with the exception of CPAP / BIPAP used only for sleep apnea syndromes
3. Predictable mechanical ventilation duration <48 hours
4. Moribund patient or death expected on the day of randomization, or with a SAPS IIscore> 90
5. Cerebral deficiency with dilated areactive pupils or irreversible neurologicalpathology.
6. Other concomitant severe pathology with an estimated life expectancy of less than 1year
7. Treatment with nicotine replacement therapy or varenicline or bupropion ongoing
8. Contraindication for nicotine patches:

• Pregnant or breastfeeding women
• Allergy to nicotine or to one of the excipients of the transdermal patch
• Generalized skin pathologies
• Cerebrovascular accident or acute coronary syndrome for less than 3 months
• Pheochromocytoma
• Unstable or worsening angor
• Severe cardiac arrhythmia (Defined by wearing an automatic implantabledefibrillator)
• Known severe heart failure (Defined, for this study, by systolic LV dysfunctionwith an LV ejection fraction (LVEF) of less than 30%)
• Severe renal failure (Defined by KDIGO stage 3)
• Severe hepatic impairment (Defined by a factor V <30%)
• Arteriopathy obliterating of the lower limbs stage III and IV
• Uncontrolled hyperthyroidism
• Gastroduodenal esophagitis or ulcer undergoing treatment or active

9. Patient under guardianship or curatorship
10. Patient deprived of liberty by judicial or administrative decision
11. Patient included in another interventional trial evaluating a health product