JUgular Gating for Upright Level Adjustment and Targeted Enhancement of Cerebral Perfusion (JUGULATE)

Investigators aim to demonstrate that the evolution of intracranial pressure (ICP) is nonlinear and may be influenced by jugular vein collapse. This collapse is estimated to occur at the angle where the hydrostatic pressure of the blood column matches the central venous pressure, and it can be assessed using ultrasonography. This approach allows for the determination of an individualized tilt angle, optimizing cerebral perfusion pressure without compromising venous drainage.

Study Overview

• Status: Not yet recruiting
• Conditions: Critical Care; Intracranial Pressure
• Intervention / Treatment: Procedure: Ultrasound assessment

Detailed Description

Cerebral venous drainage is a major determinant of intracranial pressure (ICP), yet the relationship between trunk inclination and ICP remains incompletely understood. Physiological data in healthy subject suggest that venous outflow may behave nonlinearly, with a threshold angle beyond which further elevation only modestly improves drainage while taking the risk of increasingly compromising cerebral perfusion pressure (CPP). The internal jugular vein (IJV) is the primary conduit for upright cerebral venous return; its collapse was estimated in healthy subjects to occurs when jugular hydrostatic pressure exceeds central venous pressure. Understanding the precise angle at which IJV collapse occurs may allow safer patient positioning strategies in critical care. Doppler ultrasonography, ICP measurements and cerebral perfusion pressure provide complementary data on this physiological breakpoint. Accurate characterization of this nonlinearity may improve cerebral perfusion management and reduce secondary brain injury.

After the routine nursing care, during patient repositioning to 30 ° assessments are performed at 0, 10° 20° 30°, and at a calculated threshold angle α. At each angle ICP, CPP and Ultrasound assessment of cerebral blood flow velocities and IJV cross-sectional area at three cervical levels are recorded.

Physiological parameters including arterial blood pressure, ICP, and cerebral perfusion pressure are recorded at each angle. Doppler ultrasonography of the middle cerebral artery is performed for flow assessment. Ventilation parameters, sedation, and vasopressor support are maintained constant. Safety criteria for immediate cessation of the procedure includes ICP >20 mmHg, CPP <60 mmHg, or oxygen desaturation, the same criteria that would have stoped the routine nursing care. Data are analyzed to characterize the nonlinear relationship between trunk angle and cerebral venous outflow, with particular focus on the collapse threshold α.

• Study Type: Observational
• Enrollment (Estimated): 30

Contacts and Locations

• Study Contact: Name: David ROURE; Phone Number: +33 05 57 87 02 01; Email: david.roure@chu-bordeaux.fr

Study Locations

• France
  • Bordeaux, France
    • Bordeaux University Hospital
    • Contact: David ROURE; Phone Number: +33 05 57 87 02 01; Email: david.roure@chu-bordeaux.fr
    • Principal Investigator: Grégoire CANE, Dr
    • Sub-Investigator: David ROURE

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patient hospitalized in the neurocritical care unit or the trauma unit

Description

Inclusion Criteria:

• Patients ≥ 18 years old
• Hospitalized in the neurocritical care unit or the trauma unit
• Scheduled for nursing care requiring a supine position.
• Arterial catheter allowing continuous measurement of mean arterial pressure.
• Central venous catheter for continuous measurement of central venous pressure.
• External ventricular drain or intracranial pressure sensor for intracranial pressure monitoring.
• Bed with controlled inclination capability.
• Clinically stable condition allowing transient positional changes (as judged by the clinician).
• Not included, or planned to be included in another trial.

Exclusion Criteria:

• Contraindication to trunk mobilization.
• Being a minor or placed under supervision.
• Hemodynamic or respiratory instability.
• Uncontrolled intracranial hypertension, refractory arterial hypertension, or severe dysautonomia.
• Pregnancy or breastfeeding.
• Refusal to participate in the study.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Experimental group; Patients ≥ 18 years old hospitalized in the neurocritical care unit or the trauma unit in clinically stable condition allowing transient positional changes	Procedure: Ultrasound assessment; After the routine nursing care, during patient repositioning to 30 ° assessments are performed at 0, 10° 20° 30°, and at a calculated threshold angle α. At each angle intracranial pressure , cerebral perfusion pressure and ultrasound assessment of cerebral blood flow velocities and internal jugular vein cross-sectional area at three cervical levels are recorded.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intracranial pressure	After the routine nursing care, during patient repositioning to 30 ° assessments are performed at 0, 10° 20° 30°, and at a calculated threshold angle α. At each angle intracranial pressure is recorded.	At inclusion (day 0)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cerebral perfusion pressure at 30° and at angle α (1)	Comparison of Cerebral perfusion pressure values based on mean arterial pressure measured at the tragus and intracranial pressure obtained via transcranial Doppler using a cardiac probe at the M1 segment of the ipsilateral middle sylvian artery corresponding to the jugular vein under study.	At inclusion (day 0)
Cerebral perfusion pressure at 30° and at angle α (2)	Comparison of Cerebral perfusion pressure values based on diastolic, systolic, and mean blood flow velocities obtained via transcranial Doppler using a cardiac probe at the M1 segment of the ipsilateral middle sylvian artery corresponding to the jugular vein under study.	At inclusion (day 0)
Cerebral perfusion pressure at 30° and at angle α (3)	Comparison of Cerebral perfusion pressure values based on pulsatility index obtained via transcranial Doppler using a cardiac probe at the M1 segment of the ipsilateral middle sylvian artery corresponding to the jugular vein under study.	At inclusion (day 0)
Intracranial pressure	Ultrasound measurement using a vascular probe at angles of 0°, 10°, 20°, 30°, and the calculated angle α.	At inclusion (day 0)
Variation in internal jugular vein luminal cross-sectional area.	Intra-subject statistical analysis for modeling the relationship between angle and intracranial pressure	At inclusion (Day 0)

Collaborators and Investigators

• Sponsor: University Hospital, Bordeaux
• Investigators: Principal Investigator: Grégoire CANE, Dr, University Hospital, Bordeaux

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2026
• Primary Completion (Estimated): March 31, 2027
• Study Completion (Estimated): March 31, 2027

Study Registration Dates

• First Submitted: June 4, 2026
• First Submitted That Met QC Criteria: June 18, 2026
• First Posted (Actual): June 24, 2026

Study Record Updates

• Last Update Posted (Actual): June 24, 2026
• Last Update Submitted That Met QC Criteria: June 18, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Critical care; Intracranial Pressure; jugular vein collapse
• Other Study ID Numbers: CHUBX 2026/011

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No