Brain Monitoring During PEEP-Based Respiratory Therapy in Critically Ill Patients
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age18+
SponsorShengli Oilfield Hospital
About this trial
Mechanical ventilation is commonly used in critically ill patients with acute brain injury. Positive end-expiratory pressure (PEEP) and lung recruitment maneuvers are important ventilator strategies for improving oxygenation, but they may also influence cerebral blood flow, systemic hemodynamics, carbon dioxide levels, and brain electrical activity. The effects of PEEP-related ventilator changes on cortical function in neurocritical care patients remain insufficiently understood.
This prospective observational physiological study will evaluate changes in brain electrical activity and cerebral blood flow during clinically indicated lung recruitment maneuvers and PEEP adjustments in mechanically ventilated neurocritical care patients. Multimodal monitoring will include electroencephalography (EEG), transcranial Doppler ultrasound, invasive arterial blood pressure, end-tidal carbon dioxide, and routine clinical variables.
EEG-derived measures, including delta power ratio and related frequency-domain indicators, will be used to describe cortical activity. Cerebral blood flow velocity and low-frequency neurovascular coupling measures will be explored as secondary physiological outcomes. The study will examine whether PEEP-related changes are associated with alterations in EEG activity, cerebral blood flow, and neurovascular coupling, and whether these responses differ according to clinical status.
The results may help improve understanding of brain-lung interactions during mechanical ventilation and inform future studies on individualized ventilation strategies in neurocritical care.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Age ≥18 years.
Admission to the neurocritical care unit with acute brain injury requiring intensive care management.
Receiving invasive mechanical ventilation.
Undergoing clinically indicated recruitment maneuvers and positive end-expiratory pressure (PEEP) adjustments.
Disqualifiers
Pregnancy.
Hemodynamic instability precluding recruitment maneuvers or PEEP adjustments.
Severe cardiac dysfunction judged by the treating physician to contraindicate study procedures.
Inability to obtain adequate transcranial Doppler signals.
Trial design
Design model
Single group
Treatments tested in this trial
Recruitment Maneuver
Procedure/SurgeryA standardized lung recruitment maneuver performed during mechanical ventilation to transiently increase airway pressure and reopen collapsed alveoli. Physiological responses are continuously monitored using multimodal neuromonitoring and hemodynamic monitoring systems.
Positive End-Expiratory Pressure Adjustment
Procedure/SurgeryPositive end-expiratory pressure (PEEP) levels are adjusted according to the study protocol during mechanical ventilation. Cerebral electrophysiological activity, cerebral blood flow, systemic hemodynamics, and respiratory parameters are continuously recorded during PEEP modifications.
Treatment groups
50 Participants
are divided into 1 treatment groupGroup A: PEEP-Based Respiratory InterventionExperimental treatment 2 interventions
Trial outcomes
Primary outcomes
1
Change in EEG Delta Power Ratio During PEEP-Based Respiratory Interventions
Change in electroencephalography (EEG)-derived delta power ratio (DPR) measured before, during, and after recruitment maneuvers and positive end-expiratory pressure (PEEP) adjustments. DPR is calculated as the proportion of delta-band power relative to total EEG power and is used as an indicator of cortical electrophysiological activity.
Time frame
During ventilator interventions (baseline, intervention, and recovery periods; approximately 30 minutes)Secondary outcomes
1
Change in Cerebral Blood Flow Velocity
Changes in cerebral blood flow velocity measured by transcranial Doppler ultrasonography during recruitment maneuvers and PEEP adjustments.
Time frame
During ventilator interventions (approximately 30 minutes)2
Change in Neurovascular Coupling Index
Changes in neurovascular coupling quantified by phase-amplitude coupling analysis between low-frequency cerebral blood flow oscillations and EEG activity.
Time frame
During ventilator interventions (approximately 30 minutes)3
Change in Mean Arterial Pressure
Changes in invasive mean arterial pressure during recruitment maneuvers and PEEP adjustments.
Time frame
During ventilator interventions (approximately 30 minutes)Sponsors and contacts
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Source ClinicalTrials.gov