The Contribution of the Combination of Transthoracic and Transcranial Ultrasonography to the Titration of Positive End-expiratory Pressure in Patients With Acute Respiratory Distress Syndrome and Acute Brain Injury

What this Trial Is About

This research aims to evaluate whether combining lung and brain ultrasonography helps select the best positive end-expiratory pressure (PEEP) for critically ill patients who are mechanically ventilated with acute respiratory distress syndrome (ARDS) and acute brain injury (ABI). The study focuses on creating an individualized ventilation strategy that protects the brain while managing lung function. This is important because improving lung aeration may affect brain pressure and blood flow. Participants will undergo a stepwise increase of PEEP at four levels: 5, 8, 12, and 16 cmH2O. After each increase, lung ultrasound will assess lung aeration patterns using the Lung Ultrasound Score, and transcranial Doppler ultrasonography will evaluate cerebral blood flow and intracranial pressure indicators. Researchers will record intracranial pressure, brain oxygen levels, respiratory mechanics, and arterial blood gases during the approximately 120-minute procedure. During the study, each participant serves as their own control. Researchers will monitor lung and brain function continuously to find the optimal PEEP level that balances lung and brain needs. They will measure differences in PEEP levels guided by lung and brain ultrasound, and follow clinical outcomes up to 90 days after intervention. The study includes safety monitoring and detailed assessments to develop a brain-protective ventilation approach for these critically ill patients.

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