Cerebrovascular Hemodynamics in Patients With ARDS.

Study Overview
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Brief Summary
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The acute respiratory distress syndrome (ARDS) is a life-threatening disease with functional impairment of the lung. It is characterized by an excessive inflammatory response of lung tissue, capillaries, and blood vessels and is associated with high mortality. Patients who survive the acute phase of this critical disease often suffer from long-term physical, psychological, and mental sequelae, as well as persistent cognitive deficits. In healthy individuals, autoregulatory mechanisms of the intracranial blood vessels keep blood supply to the brain independent of fluctuations in systemic blood pressure. In the case of a serious illness, these mechanisms of autoregulation may be impaired, which may favor cerebral hypoperfusion. Impairment of cerebrovascular hemodynamics can lead to neuronal damage in short and long term. The aim of this project is to investigate cerebrovascular autoregulation in adult patients with ARDS and to evaluate the cognitive outcome at 3, 6 and 12 months after discharge from the intensive care unit.

Official Title
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Cerebrovascular Hemodynamics and Neurocognitive Outcome in Patients With Acute Respiratory Distress Syndrome.

Conditions
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ARDS

Intervention / Treatment
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* Diagnostic Test: Near-infrared spectroscopy-based assessement of cerebral autoregulation.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ARDS Exclusion Criteria: Pre-existing neurological diseases with known intracranial pathology Cerebrovascular disorders, including hemodynamically relevant extracranial vascular stenoses

Ages Eligible for Study
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Minimum Age: 18 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Adult patients with ARDS<br>Adults patients fulfilling the Berlin criteria for ARDS | Diagnostic Test: Near-infrared spectroscopy-based assessement of cerebral autoregulation.<br>* Cerebral autoregulation is assessed using a software that calculates correlation coefficients based on the values of cerebral oxygenation (detected by near-infrared spectroscopy) and invasively measured arterial blood pressure. Correlation coefficients are calculated at 10-second intervals and averaged over a period of 300 seconds, resulting in an autoregulation index (cerebral oxygenation index, COx). The index can range between -1 and +1. It provides information about cerebral autoregulation capacity, with a value below 0.3 indicating intact cerebral autoregulation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| COx | Cerebral Oximetry Index (COx) as a moving correlation between arterial blood pressure and cerebral oximetry with a range from -1 to +1. A COx above 0.3 is defined as impaired cerebrovascular autoregulation. The minutes with COX above 0.3 will be assessed. | Assessment for 60 minutes per day during the acute phase of ARDS (maximum 14 days after ARDS onset). | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cognitive Failures Questionnaire (CFQ) | The Cognitive Failures Questionnaire is a self-report scale used to assess forgetfulness or inattention. It contains 25 items that are rated on a 5-point Likert scale, resulting in a total CFQ score varying from 0 to 100, with higher scores indicating more cognitive failures. | 3, 6 and 12 months after discharge from ICU. | 
| The Short Form (36) Health Survey (SF-36) | The SF-36 is a questionnaire used to assess patient-reported health. It contains eight health-related topics. Each topic is rated on a scale from 0 to 100 with lower scores representing more disability. | 3, 6 and 12 months after discharge from ICU. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cerebral Autoregulation, Cerebral Hemodynamics, Cognitive Impairment, Near-infrared Spectroscopy