GDT-PPV Protocol in Thoracic Surgery

NCT ID: NCT04865874

Last Updated: 2022-10-10

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

88 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-09-21

Study Completion Date

2023-06-30

Brief Summary

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Peri-operative fluid-therapy is extremely important in thoracic surgery, because excessive administration of fluids during one-lung ventilation is correlated to an increasing risk of postoperative respiratory complications.

Therefore, current guidelines on peri-operative management of patients undergoing thoracic surgery suggest a conservative fluid management strategy, based on intra-operative fluid loss replacement and maintenance of euvolemia.

Nevertheless, intra-operative fluid loss estimation and consequently the correct infusion rate adoption are quite difficult to be addressed in clinical practice, and this often prevents the euvolemia maintenance in the peri-operative period.

This limit claims the necessity to adopt new methods of fluid-therapy administration in thoracic surgery; among these the most promising is the "Goal-Directed Therapy" (GDT). GDT protocols based on Stroke Volume Variation (SVV) or Pulse Pressure Variation (PPV) monitoring have been adopted successfully in major and cardiac surgery but not yet in thoracic surgery.

The aim of this randomized study is to evaluate the effects of a PPV-GDT fluid management protocol versus a conservative "zero-balance" protocol on intrapulmonary gas exchanges, in patients undergoing single-lung ventilation during thoracic surgery.

Detailed Description

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The intra-operative fluid-therapy (using lactated Ringer) will be based on pulse pressure variation (PPV group) with a target ≤5.8% or on compensation (1:1) of urine output (zero balance group).

In both groups an intraoperative background infusion of lactated Ringer at 1-2 ml/kg/h will be administered.

Conditions

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Thoracic Surgery Fluid-therapy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized clinical trial
Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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PPV-GDT

Intra-operative fluid-therapy based (lactated Ringer) on continous PPV monitoring (target ≤5.8%)

Group Type EXPERIMENTAL

PPV-GDT

Intervention Type OTHER

fluid-therapy based on PPV monitoring

Zero balance

Intra-operative fluid-therapy (lactated Ringer) based on 1:1 compensation of urinary output

Group Type ACTIVE_COMPARATOR

Zero-balance

Intervention Type OTHER

fluid-therapy based on urinary output balance

Interventions

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PPV-GDT

fluid-therapy based on PPV monitoring

Intervention Type OTHER

Zero-balance

fluid-therapy based on urinary output balance

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Adult patients scheduled for Video-assisted thoracic surgery (VATS) lobectomy

Exclusion Criteria

* Patients who will not sign the informed consent
* Obesity (BMI \> 35 kg/m2)
* Cardiovascular disease (heart failure, arrhythmia)
* OSAS requiring or not C-PAP therapy
* Chronic alcoholism
* intraoperative blod loss\> 1500 ml
* One-lung ventilation duration\< 60 min
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fondazione Policlinico Universitario Agostino Gemelli IRCCS

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Paola Aceto, MD,PhD

Role: PRINCIPAL_INVESTIGATOR

Fondazione Policlinico Universitario Agostino Gemelli IRCCS

Locations

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UOC Anestesia delle Chirurgie Generali e dei Trapianti, Fondazione Policlinico Universitario A. Gemelli IRCCS

Rome, Lazio/Rome, Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Paola Aceto, MD,PhD

Role: CONTACT

+390630154507

Giovanni Punzo, MD

Role: CONTACT

+390630154507

Facility Contacts

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Paola Aceto, MD

Role: primary

00390630154507

Other Identifiers

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3901

Identifier Type: -

Identifier Source: org_study_id

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