Perioperative Hemodynamic Optimization in High-Risk Patients Using Less-Invasive Monitoring Methods

NCT ID: NCT00375271

Last Updated: 2006-09-12

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 400 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2006-08-31
• Study Completion Date: 2007-06-30

Brief Summary

The aim of this study is to evaluate different strategies of hemodynamic optimization in high risk surgical patients during the first twelve postoperative hours in ICU based on a protocol guided by a less invasive monitorig tool (Vigileo®), oriented by a fiberoptic central venous catheter that allows continuous monitorig of SvcO2 (PreSep®), and a pressure transducer (FloTrac®) that allows cardiac output calculation by the standard deviation of mean arterial pressure or a standard resuscitation strategy.

Detailed Description

Patients submitted to high risk surgical procedures generally show a hyperdynamic pattern due to the metabolic response after the surgical trauma. This response is fundamentally dependent on their functional reserve and on the treatment. Data from UK show an aged population with 15 to 30% of mortality in the first thirty days after surgery, generally having respiratory or cardiac co-morbidities1. Identification of these patients besides protocol implementation aiming to an appropriate support is the basic strategy to warrant a better outcome in the post-operative period.

Shoemaker has established the definition criteria to high risk patients at the end of the 80's. Those criteria are accepted until today. He too demonstrated the benefits of hemodynamic optimization in order to achieve "supra-normal" oxygen delivery.

Unfortunately, in the years to come, there was a backlash in this concept due to results of several heterogeneous and misleading studies that cast doubts about the efficacy of that strategy. Heyland, however, observed benefit when the hemodynamic optimization was instituted before the surgery.

In the 90's, support to high risk surgical patients had a new start, with publication of several studies demonstrating reduction on morbidity, mortality, and hospital and ICU lengths of stay. In a recent metaanalysis of twenty one studies, Kern and Shoemaker concluded that there was mortality reduction when hemodynamic optimization was started early before organ dysfunction has ensued. There was greater benefit in those studies where the control group had a 20% mortality or more and when the therapy achieved differences on oxygen delivery between the control and treatment groups.

Despite the strong evidence favoring hemodynamic optimization, as long as the high risk patients are identified, more studies are necessary to better answer some questions such as: what is the importance of volemic replacement, what is the best solution to be used, and what is the best method for monitoring for the patient response. Catecholamines must be used carefully, despite their theoretic capacity of modulating inflammatory response. It appears that optimization has to be done early in the pre-operative period when organ dysfunction has not ensued yet. We have to discover for how long the optimization has to be maintained during and after the surgery.

Conditions

Postoperative Care

Keywords

Monitoring, Intraoperative; Hemodynamic Processes; Treatment Protocols

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Interventions

perioperative hemodynamic optimization protocol

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Age > 18 years
• High risk elective surgeries* according to adapted Shoemaker criteria.
• Request of post-operative support by the surgeon and anesthetist.
• Patients that have need of central venous and arterial catheters according to surgeon, critical care physician or anesthetist evaluation.
• Informed consent will be obtained from all patients enrolled or their next of kin.

Exclusion Criteria

• Patients with terminal disease, submitted to palliative surgery;
• Cardiac failure class IV of NYHA;
• Chronic renal failure without dyalisis and intolerant to fluids;

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Centro de Estudos Mário César de Rezende

OTHER

Sponsor Role: lead

Principal Investigators

Ederlon Rezende, MD

Role: STUDY_CHAIR

Hospital do Servidor Publico Estadual

Álvaro Réa-Neto, MD

Role: PRINCIPAL_INVESTIGATOR

Hospital de Clínicas da Universidade Federal do Paraná

Ciro L Mendes, MD

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitário da Universidade Federal da Paraíba

Fernando S Dias, MD

Role: PRINCIPAL_INVESTIGATOR

Hospital São Lucas da Pontifice Universidade Católica do Rio Grande do Sul

José Eduardo C Castro, MD

Role: PRINCIPAL_INVESTIGATOR

Hospital Copa D'Or

Rubens C Costa Filho, MD

Role: PRINCIPAL_INVESTIGATOR

Hospital Procardíaco

Suzana Margareth A Lobo, MD

Role: PRINCIPAL_INVESTIGATOR

Hospital de Base da Faculdade de Medicina de São José do Rio Preto

Locations

Hospital do Servidor Público Estadual

São Paulo, São Paulo, Brazil

Site Status: RECRUITING

Countries

Brazil

Central Contacts

Ederlon Rezende, MD

Role: CONTACT

Phone: 55-11-50888146

Email: ederlon@sti-hspe.com.br

Renata Andréa P Pereira, RN

Role: CONTACT

Phone: 55-11-50888192

Email: renata@sti-hspe.com.br

Facility Contacts

Ederlon Rezende, MD

Role: primary

Renata Andréa P Pereira, RN

Role: backup

Other Identifiers

25000.185884/2005-15

Identifier Type: -

Identifier Source: secondary_id

CONEP 12523

Identifier Type: -

Identifier Source: org_study_id