Clinical Research Directory

Inclusion Criteria: Critically ill patients in hospital and at least 1 of the following: 1. Acute respiratory distress syndrome (ARDS). ARDS as defined by: 1. a known acute clinical insult or new or worsening respiratory dysfunction 2. receiving respiratory support via invasive mechanical ventilation or non- invasive mechanical ventilation including continuous positive airway pressure, or high flow nasal oxygen greater than or equal to 30L/min 3. within the same 24-hour time period: i. bilateral opacities on chest imaging not fully explained by effusion, lobar/lung collapse/atelectasis, or nodules ii. respiratory failure not fully explained by cardiac failure, fluid overload, pulmonary embolism, acute airway disease iii. Pa02/Fi02 ration \<40 kPa from arterial blood gases, or Sp02 \<315 from pulse oximetry where Sp02 \<97 2. A pandemic associated syndrome Exclusion criteria: Simvastatin: 1. More than 48 hours from the diagnosis of AHRF 2. Patient is known to be pregnant 3. Liver transaminases \>8 times the upper limit of the normal range 4. Creatine kinase \>10 times the upper limit of the normal range 5. Currently receiving ongoing treatment with any of the following: itraconazole, ketoconazole, HIV protease inhibitors, nefazodone, cyclosporine, amiodarone, verapamil, or diltiazem. 6. Severe renal impairment (eGFR \< 30mL/min and not receiving renal replacement therapy). 7. Current or recent treatment (within 2 weeks) with statins 8. Physician decision that a statin is required for proven indication 9. Contraindication to enteral drug administration, e.g., patients with mechanical bowel obstruction. Patients with high gastric aspirates due to an ileus are not excluded. 10. Known hypersensitivity to simvastatin Baricitinib 1. More than 48 hours from the diagnosis of AHRF 2. Patient is known to be pregnant 3. Liver transaminases \>8 times the upper limit of the normal range 4. Absolute neutrophil count less than 0.5x10 9/L 5. Currently receiving ongoing immunosuppressants (high dose corticosteroids, B and T cell targeted therapies, interferon, or JAK inhibitors) 6. Severe renal impairment (eGFR \< 15mL/min) or receiving renal replacement therapy 7. Known active tuberculosis infection or, if known, latent TB treated for less than 4 weeks with appropriate anti-tuberculosis therapy per local guidelines. 8. Contraindication to enteral drug administration, e.g., patients with mechanical bowel obstruction. Patients with high gastric aspirates due to an ileus are not excluded. 9. Known hypersensitivity to baricitinib