Perioperative Hemodynamic Optimization Using the NICOM Device

NCT ID: NCT01217151

Last Updated: 2012-11-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

142 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-01-31

Study Completion Date

2012-11-30

Brief Summary

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In the last years, there is a growing interest in the improvement of prognosis and shortening of hospital length of stay in high-risk surgical patients. Several evidence-based protocols ("fast-track" surgery) have been developed and implemented in some hospitals for this purpose. Cardiovascular optimization through the so-called "goal-directed therapy" (GDT) is a key element in these protocols. Previous studies in the literature use invasive monitors to assess hemodynamics. The NICOM ™ is a non-invasive monitor validated in several clinical scenarios. The aim of the present randomized, international, multi-center, open-label clinical trial is to use a GDT protocol (including colloid boluses and vasoactive drug infusion) based on data obtained from the NICOM™ device (cardiac index and mean arterial pressure) to test the hypothesis that GDT is superior to standard practice in terms of reduction in the incidence of perioperative complications and length of hospital stay in high-risk major abdominal surgery patients (requiring ICU surveillance for, at least, 24 hours). As secondary objectives, time to first flatus, wound infection, anastomotic leaks and mortality will be analysed. All patients will be followed from the day of surgery up to hospital discharge (determined by a specialist surgeon not involved in the study) or death.

Detailed Description

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Conditions

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Major Abdominal Surgery

Keywords

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Hemodynamic Monitoring Goal-Directed Therapy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Usual treatment

The hemodynamic management will be performed according to the institution's standard of care, using fluids at the discretion of the anesthesiologist and the ICU specialist.

Group Type SHAM_COMPARATOR

Usual treatment

Intervention Type OTHER

Hemodynamic monitoring based on common practice

NICOM

For volume replacement, crystalloids will be used following the standard procedure according to the anesthesiologist or ICU specialist. Mean arterial pressure and cardiac index will be assessed every 5 minutes, and a volume bolus (250 mL colloid in 10 minutes) will be used to achieve a:

* Mean arterial pressure ≥ 65 mmHg (intra and postoperatively), AND
* Cardiac index ≥ 2.5 L/min/m2 (intra and postoperatively).

If these cardiovascular parameters are not met after the first colloid infusion, a supplementary bolus will be added. In case of not achieving the target, additional colloid boluses and/or pharmacologic support (norepinephrine in case of persistent hypotension, dobutamine in case of low cardiac output) will be provided according to the protocol

Group Type ACTIVE_COMPARATOR

Hemodynamic monitoring

Intervention Type DEVICE

Hemodynamic monitoring based on the NICOM device

Interventions

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Hemodynamic monitoring

Hemodynamic monitoring based on the NICOM device

Intervention Type DEVICE

Usual treatment

Hemodynamic monitoring based on common practice

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Adult patients scheduled for:
* Open colorectal surgery: hemicolectomy, pancolectomy, abdomino-perineal resection.
* Gastrectomy.
* Small bowel resection.
* Signed written informed consent.

Exclusion Criteria

* Less than 18 years old.
* Laparoscopic procedure.
* Emergency surgery.
* Intra-abdominal infection.
* Patients not requiring ICU admission (patients should stay for at least the first day at the ICU).
* Life expectancy lower than 60 days.
* Disseminated malignancy.
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital of the Nuestra Señora de Candelaria

OTHER

Sponsor Role collaborator

Hospital del Rio Hortega

OTHER

Sponsor Role collaborator

Hospital General de Ciudad Real

OTHER

Sponsor Role collaborator

University of Valencia

OTHER

Sponsor Role collaborator

Carmel Medical Center

OTHER

Sponsor Role collaborator

Hospital Universitario La Paz

OTHER

Sponsor Role lead

Responsible Party

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Hospital Universitario La Paz

Principal Investigators

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David Pestaña, M.D. Ph.D

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitario La Paz

Locations

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Carmel Medical Center

Haifa, , Israel

Site Status

Hospital General

Ciudad Real, , Spain

Site Status

Hospital Universitario Nuestra Señora de la Candelaria

Santa Cruz de Tenerife, , Spain

Site Status

Hospital Universitario Río Hortega

Valladolid, , Spain

Site Status

Countries

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Israel Spain

References

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Squara P, Rotcajg D, Denjean D, Estagnasie P, Brusset A. Comparison of monitoring performance of Bioreactance vs. pulse contour during lung recruitment maneuvers. Crit Care. 2009;13(4):R125. doi: 10.1186/cc7981. Epub 2009 Jul 28.

Reference Type BACKGROUND
PMID: 19638227 (View on PubMed)

Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED. Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [ISRCTN38797445]. Crit Care. 2005;9(6):R687-93. doi: 10.1186/cc3887. Epub 2005 Nov 8.

Reference Type BACKGROUND
PMID: 16356219 (View on PubMed)

Lopes MR, Oliveira MA, Pereira VO, Lemos IP, Auler JO Jr, Michard F. Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot randomized controlled trial. Crit Care. 2007;11(5):R100. doi: 10.1186/cc6117.

Reference Type BACKGROUND
PMID: 17822565 (View on PubMed)

Benes J, Chytra I, Altmann P, Hluchy M, Kasal E, Svitak R, Pradl R, Stepan M. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Crit Care. 2010;14(3):R118. doi: 10.1186/cc9070. Epub 2010 Jun 16.

Reference Type BACKGROUND
PMID: 20553586 (View on PubMed)

Gan TJ, Soppitt A, Maroof M, el-Moalem H, Robertson KM, Moretti E, Dwane P, Glass PS. Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology. 2002 Oct;97(4):820-6. doi: 10.1097/00000542-200210000-00012.

Reference Type BACKGROUND
PMID: 12357146 (View on PubMed)

Other Identifiers

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GDT NICOM

Identifier Type: -

Identifier Source: org_study_id