Lung and brain ultrasound to guide PEEP in adults with ARDS and acute brain injury
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
This trial will test whether combining lung and transcranial ultrasound helps doctors choose the best PEEP level for adults on a ventilator with ARDS and acute brain injury.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 30 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | George Papanicolaou Hospital Academic / other |
| Locations | 1 site (Thessaloniki) |
| Trial ID | NCT07248995 on ClinicalTrials.gov |
What this trial studies
This interventional study uses a stepwise PEEP increase protocol in mechanically ventilated adults who have ARDS and acute brain injury. Lung ultrasound will provide a Lung Ultrasound Score to track aeration and guide recruitment maneuvers, while transcranial Doppler will monitor cerebral blood flow surrogates such as the pulsatility index to detect adverse cerebral responses. Investigators will integrate both imaging assessments to select a PEEP level that improves lung function without compromising cerebral hemodynamics. The overarching aim is to develop an individualized, brain-protective ventilation strategy for this high-risk population.
Who should consider this trial
Good fit: Adults (≥18) with severe acute brain injury and ARDS within the first 10 days of ICU admission who are mechanically ventilated, have invasive neuromonitoring, and acceptable ultrasound acoustic windows are ideal candidates.
Not a fit: Patients with severe chronic brain or pulmonary disease, brain tumor or CNS infection, decompressive craniectomy, severe coagulopathy, poor acoustic windows, or those without invasive neuromonitoring are unlikely to benefit from this protocol.
Why it matters
Potential benefit: If successful, this approach could identify safer PEEP settings that improve oxygenation while minimizing increases in intracranial pressure, potentially reducing respiratory and neurological complications.
How similar studies have performed: Lung ultrasound and transcranial Doppler have been used separately to guide ventilation and monitor cerebral hemodynamics, but combining them to titrate PEEP in ARDS with acute brain injury is relatively novel and has limited prior evidence.
Eligibility criteria
Show full inclusion / exclusion criteria
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
Where this trial is running
Thessaloniki
- George Papanikolaou General Hospital — Thessaloniki, Greece (Recruiting)
Study contacts
- Principal investigator: Theodoros Schizodimos, MD — 2nd Intensive Care Unit, George Papanikolaou General Hospital of Thessaloniki
- Study coordinator: Theodoros Schizodimos, MD
- Email: teoschizo@gmail.com
- Phone: +306973439717
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.