Contribution of Transthoracic and Transcranial Ultrasonography to the Titration of PEEP in Patients With ARDS and ABI

Theodoros Schizodimos

Status: Enrolling

Conditions: Acute Respiratory Distress Syndrome (ARDS); Acute Brain Injury

Treatments: Procedure: Stepwise Positive End-Expiratory Pressure (PEEP) Increase Protocol

Study type: Interventional

Funder types: Other

Identifiers

NCT07248995

10957

Details and patient eligibility

About

The present study will investigate whether the combined use of lung and brain ultrasonography is useful in selecting the optimal positive end-expiratory pressure in mechanically ventilated critically ill patients with acute respiratory distress syndrome and acute brain injury, aiming at an individualized, brain-protective ventilation strategy.

Full description

The present study aims to evaluate whether the combined use of lung ultrasonography and brain ultrasonography can assist in determining the optimal positive end-expiratory pressure (PEEP) in mechanically ventilated, critically ill patients with acute respiratory distress syndrome (ARDS) and acute brain injury (ABI). In patients with concomitant respiratory and neurological injury, selecting an appropriate PEEP level is particularly challenging, as strategies that improve lung aeration may simultaneously increase intracranial pressure or compromise cerebral hemodynamics.

Lung ultrasound will be used to assess aeration patterns and guide lung recruitment through the Lung Ultrasound Score (LUS), while transcranial Doppler ultrasonography will be used to evaluate cerebral blood flow and intracranial pressure surrogates, such as the pulsatility index. By integrating both assessments, the study seeks to identify a PEEP level that optimizes pulmonary function while minimizing adverse effects on cerebral physiology. The overarching goal is to develop an individualized, brain-protective ventilation strategy for patients with ARDS and ABI.

Enrollment: 30 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age ≥ 18 years
• Severe acute brain injury (e.g., traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke)
• Development of ARDS (according to Berlin criteria) within the first 10 days of ICU admission

Exclusion criteria

• Severe chronic brain diseases
• Brain tumor or central nervous system (CNS) infection
• Severe chronic pulmonary or cardiovascular disease
• Severe coagulopathy
• Undergoing decompressive craniectomy
• Lack of invasive neuromonitoring
• Withdrawal of life-sustaining treatment
• Poor acoustic window in ultrasound

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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30 participants in 1 patient group

Stepwise PEEP Elevation Protocol Arm

Experimental group

Description:

All participants with ARDS and ABI will undergo a protocolized stepwise increase of PEEP at four levels. Each participant will serve as their own control.

Treatment:

Procedure: Stepwise Positive End-Expiratory Pressure (PEEP) Increase Protocol