Goal Directed Fluid Management , Pvi

NCT ID: NCT03956901

Last Updated: 2020-07-13

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

112 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-04-08

Study Completion Date

2020-06-20

Brief Summary

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The first objective of this study is to compare the liberal fluid management (LFM) with PVI guided goal-directed fluid management (GDFM) in gynecologic oncologic cases in terms of controlled intraoperative fluid balance, blood lactate levels, hemodynamic parameters, and postoperative serum creatinine levels. 112 patients who are in ASA I-II-lll risk groups included in this prospective study.

Detailed Description

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Objectives: The first objective of the investigators's study was to compare the liberal fluid management (LFM) with PVI guided goal-directed fluid management (GDFM) in terms of controlled intraoperative fluid volume, surgical end-point fluid balance, blood lactate and serum creatinine levels.

The investigators's secondary purpose was to compare the effects of different fluid regimens on the postoperative kidney injury and the duration of hospital stay.

Methods: The study included 112 American Society of Anesthesiologists (ASA) grade I ,ll and lll patients, aged above 18 and undergoing elective gynecologic oncologic case . After premedication with 0.03 mg /kg i.v. midazolam, all patients were started an i.v. infusion of 500 mL 0.9 % NaCl until the end of anesthesia induction.

After the anesthesia induction, while 0.9 % NaCl at rate of 2 mL/kg/h was infused in PVI- guided GDFM group, a 250-mL bolus cyristalloid/kolloid injection was administered when PVI was higher than 13 % over 5 min. While 0.9 % NaCl at rate of 4- 8 mL/kg/h was infused in LFM group, a 250-ml bolus cyristalloid/ kolloid injection was administered when the mean arterial blood pressure (MAP) decreased below 65 mmHg. In both groups, when MAP was still \< 65 mmHg after fluid bolus infusion, 5 mg i.v. bolus ephedrine was administered. The data collected during intraoperative period, such as heart rate, MAP, arterial blood gas samples (Ph, arterial oxygen pressure (PaO2), arterial carbon dioxide pressure (PaCO2), HCO3 level, hemoglobin, blood lactate level) were recorded. Hemoglobin, Na, K, Cl, serum creatinine, blood lactate and serum albumin scores were measured preoperatively, and up to 24 hours postoperative.

In the first 24 hours after surgery, urine output, need for blood transfusion ,lokositoz,fever,stay in icu and length of hospital stay were recorded.

Conditions

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Fluid Overload

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

SINGLE

Participants

Study Groups

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Liberal Fluid Management

liberal fluid management: 500 ml bolus crystalloid after 4-8 ml/kg/h infusion during surgery total amount of crystalloid volume of fluid infused during gycnecologcy l surgery fluid infused during whole procedure 4-8 ml/kg/h infusion during surgery If MAP \<65 mmHg or \<30%of basal value, infuse 250 ml cyristaloid/Gelofusine bolus and 5 mcg efedrin If MAP\>65 mmHg no intervention

Group Type EXPERIMENTAL

pvi guided fluid management

Intervention Type OTHER

GDFM Group: 500 ml bolus crystalloid after

2 ml \\ kg crystalloid infusion to be started

If PVI \<13 MAP is \<65 mmHg, continue infusion of fluid, 1-2 µg NE bolus to be entered after 5 min.

PVI \<13 MAP\> 65 mmHg to continue fluid infusion If PVI\> 13 MAP \<65 mmHg, 250 ml bolus crystalloid \\ colloid will be given and bolus 1-2 µg NE, If it continues after 5 minutes, liquid and NE doses will be repeated. Liquid treatment will be continued until PVI \<13.

PVI\> 13 MAP \<65 mmHg 250 ml bolus fluid to be given, if continued 5 minutes later to be repeated,repetition of fluid will continue until PVl \<13.

pvi guided fluid management

GDFM Group: 500 ml bolus crystalloid after

2 ml \\ kg crystalloid infusion to be started

If PVI \<13 MAP is \<65 mmHg, continue infusion of fluid, 1-2 µg NE bolus to be entered after 5 min.

PVI \<13 MAP\> 65 mmHg to continue fluid infusion If PVI\> 13 MAP \<65 mmHg, 250 ml bolus crystalloid \\ colloid will be given and bolus 1-2 µg NE, If it continues after 5 minutes, liquid and NE doses will be repeated. Liquid treatment will be continued until PVI \<13.

PVI\> 13 MAP \<65 mmHg 250 ml bolus fluid to be given, if continued 5 minutes later to be repeated,repetition of fluid will continue until PVl \<13.

Group Type EXPERIMENTAL

pvi guided fluid management

Intervention Type OTHER

GDFM Group: 500 ml bolus crystalloid after

2 ml \\ kg crystalloid infusion to be started

If PVI \<13 MAP is \<65 mmHg, continue infusion of fluid, 1-2 µg NE bolus to be entered after 5 min.

PVI \<13 MAP\> 65 mmHg to continue fluid infusion If PVI\> 13 MAP \<65 mmHg, 250 ml bolus crystalloid \\ colloid will be given and bolus 1-2 µg NE, If it continues after 5 minutes, liquid and NE doses will be repeated. Liquid treatment will be continued until PVI \<13.

PVI\> 13 MAP \<65 mmHg 250 ml bolus fluid to be given, if continued 5 minutes later to be repeated,repetition of fluid will continue until PVl \<13.

Interventions

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pvi guided fluid management

GDFM Group: 500 ml bolus crystalloid after

2 ml \\ kg crystalloid infusion to be started

If PVI \<13 MAP is \<65 mmHg, continue infusion of fluid, 1-2 µg NE bolus to be entered after 5 min.

PVI \<13 MAP\> 65 mmHg to continue fluid infusion If PVI\> 13 MAP \<65 mmHg, 250 ml bolus crystalloid \\ colloid will be given and bolus 1-2 µg NE, If it continues after 5 minutes, liquid and NE doses will be repeated. Liquid treatment will be continued until PVI \<13.

PVI\> 13 MAP \<65 mmHg 250 ml bolus fluid to be given, if continued 5 minutes later to be repeated,repetition of fluid will continue until PVl \<13.

Intervention Type OTHER

Other Intervention Names

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liberal guided

Eligibility Criteria

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Inclusion Criteria

1. Gynecological oncologic cases
2. Patients over 18 years old
3. ASA 1-2-3 patients

Exclusion Criteria

1. Patients with peripheral arterial disease
2. Patients with non-sinus rhythm, arrhythmia, atrial fibrillation
3. Patients with entry MAP \<65 mmHg
4. Patients with advanced renal and hepatic impairment
5. Mental retarded and non-cooperative patients
6. Patients with advanced heart failure, EF \<30%
7. Patients have massive bleeding in the perioperative period, need for massive transfusion
8. Patients have acute pulmonary pathology
9. Patients with anaphylaxis who developed a blood product reaction
10. Patients who do not allow a tidal volume of 8ml / kg in a mechanical ventilator
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Bakirkoy Dr. Sadi Konuk Research and Training Hospital

OTHER_GOV

Sponsor Role lead

Responsible Party

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Güneş Özlem Yıldız

principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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güneş özlem yildiz

Role: PRINCIPAL_INVESTIGATOR

bakırköy Dr. Sadi Konuk Education hospital

Locations

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Bakırköy Dr sadi konuk Education hospital

Istanbul, , Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

Other Identifiers

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2019/152

Identifier Type: -

Identifier Source: org_study_id

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