[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"health-study-detail:100657248":3},{"organization":4,"outcomesModule":7,"designInfo":19,"detailedDescription":25,"studyPopulation":18,"armGroups":26,"interventions":37,"overallOfficials":42,"centralContacts":54,"locations":59,"responsibleParty":73,"collaborators":77,"id":79,"slug":80,"hasResults":81,"nctId":82,"briefTitle":83,"officialTitle":84,"acronym":18,"eligibilityCriteria":85,"healthyVolunteers":81,"sex":86,"minAge":87,"maxAge":18,"enrollmentInfo":88,"targetDuration":18,"studyType":91,"phases":92,"briefSummary":94,"conditions":95,"keywords":100,"overallStatus":107,"whyStopped":18,"lastUpdateSubmitDate":108,"lastUpdatePostDateStruct":109,"startDateStruct":112,"completionDateStruct":114,"leadSponsor":116,"locationsCount":117},{"fullName":5,"class":6},"Assiut University","OTHER",{"primaryOutcomes":8,"secondaryOutcomes":13,"otherOutcomes":18},[9],{"measure":10,"description":11,"timeFrame":12},"TAPSE\u002FPASP ratio (RV-PA coupling)","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.\n\nRepeat echocardiography will be performed approximately 48-72 hours after initiation of the intervention, using the same measurements.","On admission and 48-72 hours after",[14],{"measure":15,"description":16,"timeFrame":17},"Acute kidney injury progression","Serum creatinine and urine output will be recorded at baseline and daily for the first 7 days of mechanical ventilation, or until ICU discharge\u002Fdeath if earlier.\n\nAKI will be staged according to KDIGO criteria with primary renal endpoint:\n\nAKI progression, defined as an increase in KDIGO stage during the 7-day observation period. New AKI and worsening of established AKI may also be described separately.","1 week",null,{"allocation":20,"interventionModel":21,"interventionModelDescription":18,"primaryPurpose":22,"observationalModel":18,"timePerspective":18,"maskingInfo":23},"NON_RANDOMIZED","PARALLEL","SUPPORTIVE_CARE",{"masking":24,"maskingDescription":18,"whoMasked":18},"NONE","The tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE\u002FPASP) 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.\n\nSeparately, 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.\n\nThis 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\u002FPASP ratio, and reduce AKI progression in mechanically ventilated critically ill patients.",[27,33],{"label":28,"type":29,"description":30,"interventionNames":31},"Driving Pressure-Optimized Ventilation Group","EXPERIMENTAL","Patients ventilated using a standardized protocol targeting driving pressure optimization (ΔP ≤15 cmH2O\\]) through adjustment of tidal volume and\u002For PEEP, in addition to standard critical care management.",[32],"Other: Driving Pressure-Guided Ventilator Optimization",{"label":34,"type":35,"description":36,"interventionNames":18},"Standard Ventilation Group","NO_INTERVENTION","Patients ventilated according to standard ventilation practice",[38],{"type":6,"name":39,"description":40,"armGroupLabels":41,"otherNames":18},"Driving Pressure-Guided Ventilator Optimization","A ventilator management strategy in which tidal volume and\u002For PEEP are titrated to minimize driving pressure (plateau pressure - PEEP) to a pre-specified target, aiming to improve RV-PA coupling and reduce AKI progression.",[28],[43,46,50],{"name":44,"affiliation":5,"role":45},"Nardin Girgis","PRINCIPAL_INVESTIGATOR",{"name":47,"affiliation":48,"role":49},"Alaa El-Din Abdel-Moneim El-Sayed Othman","Professor of internal medicine","STUDY_CHAIR",{"name":51,"affiliation":52,"role":53},"Radwa Awad Abd-ElHafaz","Lecturer of internal medicine and nephorology","STUDY_DIRECTOR",[55],{"name":44,"role":56,"phone":57,"phoneExt":18,"email":58},"CONTACT","+2 01285151220","nadosha74@gmail.com",[60],{"facility":5,"status":18,"city":61,"state":18,"zip":18,"country":62,"countryCode":63,"cosmosGeoPoint":64,"geoPoint":69,"contacts":70},"Asyut","Egypt","EG",{"type":65,"coordinates":66},"Point",[67,68],31.18368,27.18096,{"lat":68,"lon":67},[71],{"name":44,"role":56,"phone":72,"phoneExt":18,"email":58},"+20128515220",{"type":74,"investigatorFullName":75,"investigatorTitle":76,"investigatorAffiliation":5,"oldNameTitle":18,"oldOrganization":18},"SPONSOR_INVESTIGATOR","Nardin Aymn Boshra","Assistant lecturer",[78],{"name":5,"class":6},"100657248","driving-pressure-optimization-rv-pa-coupling-and-aki-in-mechanically-ventilated-critically-ill-patients-100657248",false,"NCT07836387","Driving Pressure Optimization, RV-PA Coupling, and AKI in Mechanically Ventilated Critically Ill Patients","Effect of Driving Pressure Optimization on RV-PA Coupling (TAPSE\u002FPASP Ratio) and Acute Kidney Injury Progression in Mechanically Ventilated Critically Ill Patients","Inclusion Criteria:\n\n* Age ≥18 years.\n* ICU admission.\n* Invasive mechanical ventilation expected to continue for ≥48 hours.\n* Adequate transthoracic echocardiographic acoustic window for assessment of TAPSE\u002FPASP.\n\nExclusion Criteria:\n\n* Pre-existing end-stage renal disease on chronic dialysis.\n* Severe pulmonic or tricuspid valve disease precluding reliable TAPSE\u002FPASP assessment.\n* Pre-existing RV dysfunction of a non-pulmonary cause.\n* Pregnancy.\n* Patients expected to die within 24 hours.\n* Technically inadequate echocardiographic window.\n* Clinical contraindication to the proposed ventilation strategy.","ALL","18 Years",{"count":89,"type":90},90,"ESTIMATED","INTERVENTIONAL",[93],"NA","This study evaluates the effect of driving pressure optimization on right ventricular-pulmonary artery (RV-PA) coupling, assessed by TAPSE\u002FPASP ratio, and its association with acute kidney injury (AKI) progression in mechanically ventilated critically ill patients.",[96,97,98,99],"Acute Kidney Failure","Mechanical Ventilation Strategies","Right Ventricular (RV) Dysfunction","Critical Illness",[101,102,103,104,105,106],"Driving Pressure","RV-PA Coupling","TAPSE\u002FPASP Ratio","Mechanical ventilation","Acute Kidney Injury","KDIGO","NOT_YET_RECRUITING","2026-09-22",{"date":110,"type":111},"2026-09-23","ACTUAL",{"date":113,"type":90},"2026-10-01",{"date":115,"type":90},"2028-04-01",{"name":75,"class":6},1]