The Impact of Noradrenaline on Ventriculo-arterial Coupling and Central Cardiovascular Energy Delivery

NCT ID: NCT04745845

Last Updated: 2022-01-05

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

49 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-03-01

Study Completion Date

2021-12-31

Brief Summary

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The study aims to examine how noradrenaline in combination with venous return influences the energy transmission from heart to central circulation and arteries - also called arterio-ventricular coupling.

Detailed Description

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After being informed about the study 40 elective CABG patients with written informed consent will undergo assessment of their arterio-ventricular coupling postoperatively after coronary bypass graft surgery. Whilst still in deep general anesthesia on the CT ICU the study population will be assessed by echocardiographic examination (transthoracic and transesophageal), blood pressure tracing by arterial line, respiratory data and ECG in 4 different situations.

Initially the individual patient is either considered fluid responsive (SVV \>13%) og non- responsive (SVV\<13%) by using stroke volume variation assessed by echocardiography.

In case of fluid responsiveness a fluid bolus of 4ml/kg of crystalloid fluid is given until SVV drops below 13% and the patient can be considered as fluid NON responder.

Right afterwards the study patient is stabilized with a baseline dose of noradrenaline (NA) intravenously in a supine position (situation 1). Situation 2 will be a slight increase in NA dose stabilizing mean arterial pressure in a "baseline + 20mmHg" state. After reversing the NA dose back to base line level the patient is allowed a short period of rest to wean of drug effect (4-5 x t1/2, appr. 12min). Subsequently the patient is to be placed in a 20% semi upright position (Anti-Trendelenburg) causing an increase in fluid responsiveness (situation 3). Following a phase of equilibration the dose of NA is again titrated up to obtain a 20mmHg increase in mean arterial pressure (situation 4).

There will be logging of arterial pressure curve and VTI-tracing I LVOT simultaneously (ultrapower, uPWR) as well as calculation of energy delivery, cardiac power, oscillatory power and -fraction and both arterial and ventricular elastance in every of those 4 situations.

Conditions

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Heart Diseases

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

NONE

Study Groups

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Noradrenalin

treatment with 2 different NA concentrations in 2 different states of fluid responsiveness

Group Type EXPERIMENTAL

Noradrenalin

Intervention Type PROCEDURE

Norepinephrine challenge (concentration 'A' ) in fluid responsive position

Noradrenalin

Intervention Type PROCEDURE

Norepinephrine challenge (concentration 'A') in non-fluid responsive position

Noradrenalin

Intervention Type PROCEDURE

Norepinephrine challenge (concentration 'B') in fluid responsive position

Noradrenalin

Intervention Type PROCEDURE

Norepinephrine challenge (concentration 'B') in non-fluid responsive position

Interventions

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Noradrenalin

Norepinephrine challenge (concentration 'A' ) in fluid responsive position

Intervention Type PROCEDURE

Noradrenalin

Norepinephrine challenge (concentration 'A') in non-fluid responsive position

Intervention Type PROCEDURE

Noradrenalin

Norepinephrine challenge (concentration 'B') in fluid responsive position

Intervention Type PROCEDURE

Noradrenalin

Norepinephrine challenge (concentration 'B') in non-fluid responsive position

Intervention Type PROCEDURE

Other Intervention Names

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Anti-Trendelenburg position/Semiupright position (20degr) supine position Anti-Trendelenburg position/Semiupright position (20degr) supine position

Eligibility Criteria

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Inclusion Criteria

* elective coronary artery bypass graft surgery
* requirement for Noradrenaline/Norepinephrine

Exclusion Criteria

* lack of informed consent
* patient unsuitable for mean arterial pressure (MAP) elevation of 20mmHg
* patient requiring different blood pressure range due to medical/surgical needs
* poor image quality due to patient factors
Minimum Eligible Age

18 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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St. Olavs Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Hilde Pleym (Head of Department), md, PhD

Role: STUDY_DIRECTOR

St. Olavs Hospital

Locations

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St Olavs Hospital, Dep. for Anesthesia & Intensive care. Section of cardiothoracic Anesthesia and -intensive Care.

Trondheim, , Norway

Site Status

Countries

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Norway

Other Identifiers

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2019/287

Identifier Type: -

Identifier Source: org_study_id

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