Evaluation of Intracranial Pressure During Mechanical Ventilation Recruitment Maneuver

Study Overview
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Brief Summary
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Recruitment maneuver is used to reopen atelectasis alveoli. Positive airway pressure applied during the recruitment maneuver may increase intrathoracic pressure, resulting in hemodynamic instability, venous return disorders, and increased intracranial pressure. Our study will examine the effect of recruitment maneuver on intracranial pressure by evaluating Optic Nerve Sheath Diameter change.

Detailed Description
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The therapeutic goal of mechanical ventilation shifts from maintaining regular gas exchange to preventing ventilator-induced lung injury. Atelectasis aggravates lung injury by reducing the lung size available for tidal ventilation. By preventing atelectasis with Positive End Expiratory Pressure (PEEP) and recruitment maneuvers, the end-expiratory lung volume can be increased, and lung damage can be reduced. Although the recruitment maneuver improves oxygenation and reduces mortality, especially in patients with Acute Respiratory Distress Syndrome (ARDS), adverse side effects are sometimes observed. Most important of these are the risk of barotrauma after positive airway pressure applications, increased intrathoracic pressure and hemodynamic instability, and increased intracranial pressure risk after venous return disorder. Our study aimed to evaluate the effect of recruitment maneuver on intracranial pressure by measuring optic nerve diameter with ultrasound before and after its application in patients with ARDS with impaired oxygenation and followed up with mechanical ventilator support.

Official Title
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Evaluation of Intracranial Pressure Change by Measuring Optic Nerve Sheath Diameter During Lung Recruitment Maneuver in Patients With Acute Respiratory Distress Syndrome: A Prospective Experimental Study

Conditions
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Effect of Recruitment Maneuver on Intracranial Pressure

Intervention / Treatment
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* Diagnostic Test: The recruitment maneuver


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients older than 18 years Patients followed in the Intensive Care Unit (ICU) Patients on mechanical ventilation support Patients diagnosed with ARDS according to the Berlin criteria Patients with oxygen saturation (SpO2) ≤ 92% Exclusion Criteria: Younger than 18 Patients with increased inotropic drug requirement or mean arterial pressure <65 mmHg in the last 2 hours Patients with intracranial hypertension Patients with acute coronary syndrome Patients with hypercapnia, pneumothorax, subcutaneous emphysema, and pneumomediastinum

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Interventional Model Description: all patients in mechanical ventilation
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Effect of recruitment maneuver on intracranial pressure<br>A recruitment maneuver will be performed in patients with decreased oxygen saturation due to atelectasis by applying 30 cm H2O positive pressure support for 30 seconds. The effect of the recruitment maneuver on intracranial pressure will be investigated by measuring the optic nerve sheath diameter with the help of ultrasonography before and after the recruitment maneuver. | Diagnostic Test: The recruitment maneuver<br>* In patients with ARDS, 30 cm H2O positive pressure support and 30 seconds recruitment maneuver will be applied. The effect of the recruitment maneuver on intracranial pressure will be investigated by measuring the optic nerve sheath diameter with the help of ultrasonography before and after the recruitment maneuver. Optic nerve diameter will be evaluated with a linear probe on the eyeball before and after the collection maneuver, taking a value of 3 mm from the eyeball.<br>* Other names: Measurement of optic nerve sheath diameter with the help of ultrasonography;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Effect of recruitment maneuver on optic nerve sheath diameter (ONSD) | Change in optic nerve sheath diameter (ONSD) after the recruitment maneuver in acute respiratory distress syndrome (ARDS) patients | 1 minute | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Effect of recruitment maneuver on respiratory compliance (Cdyn) | Change in respiratory compliance (Cdyn) after the recruitment maneuver | 10 minute | 
| Effect of recruitment maneuver on oxygen saturation (SpO2) | Change in oxygen saturation (SpO2) after the recruitment maneuver | 10 minute | 
| The effect of change of respiratory compliance (Cdyn) on optic nerve sheath diameter (ONSD) after the recruitment maneuver | Effect of respiratory compliance (Cdyn) change on optic nerve sheath diameter (ONSD) change after recruitment maneuver | 10 minute | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Recruitment maneuver, Intracranial pressure, Optic Nerve Sheath Diameter, Acute respiratory distress syndrome