The main objective is to assess the effect of increased PEEP on echo-Doppler venous congestion in ARDS patients at two PEEP levels, by grading congestion in each venous flow (suprahepatic, renal, portal) as "absent," "moderate," or "severe," and also calculating the VExUS score.
Hypoxemia with a PaO₂ (mmHg)/FiO₂ (0.21 to 1.0) ratio <300 mmHg with a positive end-expiratory pressure (PEEP) ≥5 cmH₂O;
Pulmonary edema not fully explained by cardiac failure or fluid overload;
Presence of bilateral pulmonary opacities on chest imaging not fully explained by pleural effusions, atelectasis, or pulmonary nodules.
Minor patient (<18 years old)
ECMO (Extracorporeal Membrane Oxygenation)
Hemodynamic instability (mean arterial pressure <60 mmHg)
Respiratory instability (SpO₂ <90% under FiO₂ >90%)