Effect of Positive End-Expiratory Pressure Titration on Venous Excess Ultrasound Score and Renal Outcomes in Patients With Acute Respiratory Distress Syndrome

NCT07545252 — Not yet recruiting, 40 participants, Fayoum University

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Registry	NCT07545252
Status	Not yet recruiting
Study type	Observational
Enrollment	40 (Estimated)
Sponsor	Fayoum University (Other)
Conditions	Acute Respiratory Distress Syndrome (ARDS)
Interventions	VExUS score (Other)
Dates	start 2026-04-12 (estimated), primary completion 2026-09-20 (estimated), completion 2026-10-12 (estimated), first posted 2026-04-22, last updated 2026-04-22

-Summary

This study is a prospective observational cohort study conducted planned to include 40 patients with ARDS to assess the effect of different levels of PEEP titration on VExUS score and renal outcomes in patients with Acute Respiratory Distress Syndrome.

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+Detailed description

This study is a prospective observational cohort study conducted planned to include 40 patients with ARDS within 24 hours of onset and mechanically ventilated for more than 24 hours to assess the effect of different levels of PEEP titration on Venous Excess Ultrasound Score and renal outcomes in patients with Acute Respiratory Distress Syndrome.

+Arms and interventions

VExUS score (Other): The Venous Excess Ultrasound Score (VExUS) was calculated for each patient based on the assessment of systemic venous congestion using the following parameters: Inferior vena cava (IVC) diameter and respiratory collapsibility, Hepatic vein Doppler waveform, Portal vein Doppler pulsatility and Intrarenal venous Doppler pattern.

+Outcome measures

Primary outcomes

VExUS score [3 days]: Change in VExUS score in relation to different PEEP levels in mechanically ventilated patients with ARDS.
Development of acute kidney injury (AKI) [3 days]: Development of acute kidney injury (AKI), defined and staged according to the KDIGO criteria: increase in serum creatinine by ≥0.3 mg/dL within 48 hours, or ≥1.5 times baseline within 7 days, or urine output <0.5 mL/kg/hour for 6 hours.

Secondary outcomes

Requirement for renal replacement therapy (RRT) during ICU stay. [3 days]: Requirement for renal replacement therapy (RRT) during ICU stay.
Length of ICU stay [4 to 7 days]: Length of ICU stay
ICU mortality [4 to 7 days]: ICU mortality during ICU Stay

+Eligibility

Sex: All, ages: 18 Years to 18 Years

Inclusion Criteria:

* Age ≥18 years.
* Diagnosis of ARDS according to the Berlin criteria.
* Invasive mechanical ventilation ≥24 hours.
* Requirement of PEEP ≥5 cmH₂O.

Exclusion Criteria:

* Known end-stage renal disease on chronic dialysis.
* History of renal transplantation.
* Pregnancy.
* Known severe tricuspid regurgitation.
* Chronic liver disease with portal hypertension.
* Poor ultrasound window precluding adequate venous Doppler assessment.