Effect of Driving Pressure Optimization on RV-PA Coupling (TAPSE/PASP Ratio) and Acute Kidney Injury Progression in Mechanically Ventilated Critically Ill Patients
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 90
- 试验地点
- 1
- 主要终点
- TAPSE/PASP ratio (RV-PA coupling)
研究概览
简要总结
This study evaluates the effect of driving pressure optimization on right ventricular-pulmonary artery (RV-PA) coupling, assessed by TAPSE/PASP ratio, and its association with acute kidney injury (AKI) progression in mechanically ventilated critically ill patients.
详细描述
The tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio is a validated, non-invasive bedside surrogate for RV-PA coupling, shown to correlate closely with invasively measured pressure-volume loop indices of RV-arterial coupling and to carry independent prognostic value in heart failure and pulmonary hypertension populations. More recently, TAPSE-based coupling indices have also demonstrated prognostic relevance in general critically ill populations, supporting their applicability outside the setting of chronic cardiopulmonary disease.
Separately, driving pressure (the difference between plateau pressure and PEEP) has emerged as a key determinant of ventilator-induced lung injury and mortality in ARDS, independent of tidal volume or PEEP in isolation, building on earlier evidence that lower tidal volume ventilation strategies improve outcomes in acute lung injury and ARDS.
This study will investigate whether a simple standardized lung-protective ventilation strategy aimed at optimizing ventilator driving pressure can improve RV-PA coupling, assessed by TAPSE/PASP ratio, and reduce AKI progression in mechanically ventilated critically ill patients.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age ≥18 years.
- •ICU admission.
- •Invasive mechanical ventilation expected to continue for ≥48 hours.
- •Adequate transthoracic echocardiographic acoustic window for assessment of TAPSE/PASP.
排除标准
- •Pre-existing end-stage renal disease on chronic dialysis.
- •Severe pulmonic or tricuspid valve disease precluding reliable TAPSE/PASP assessment.
- •Pre-existing RV dysfunction of a non-pulmonary cause.
- •Pregnancy.
- •Patients expected to die within 24 hours.
- •Technically inadequate echocardiographic window.
- •Clinical contraindication to the proposed ventilation strategy.
研究组 & 干预措施
Driving Pressure-Optimized Ventilation Group
Patients ventilated using a standardized protocol targeting driving pressure optimization (ΔP ≤15 cmH2O]) through adjustment of tidal volume and/or PEEP, in addition to standard critical care management.
干预措施: Driving Pressure-Guided Ventilator Optimization (Other)
Standard Ventilation Group
Patients ventilated according to standard ventilation practice
结局指标
主要结局
TAPSE/PASP ratio (RV-PA coupling)
时间窗: On admission and 48-72 hours after
Baseline transthoracic echocardiography will be performed before initiation of the intervention whenever feasible, recording: TAPSE, PASP (estimated from tricuspid regurgitant jet velocity and estimated right atrial pressure), MAPSE (LV longitudinal function parameter), Inferior vena cava (IVC) collapsibility index. Repeat echocardiography will be performed approximately 48-72 hours after initiation of the intervention, using the same measurements.
次要结局
- Acute kidney injury progression(1 week)
研究者
Nardin Aymn Boshra
Assistant lecturer
Assiut University