Advanced Goal-Directed Impedancemetry Strategy for Lung Resection Surgery

NCT ID: NCT06156943

Last Updated: 2024-12-24

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

RECRUITING

Clinical Phase

NA

Total Enrollment

722 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-12-12

Study Completion Date

2027-01-31

Brief Summary

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High-risk patients scheduled for lung resection surgery are increasing and theoretically eligible to perioperative individualized goal-directed fluid therapy (GDFT). However, thoracic surgery is challenging for intraoperative stroke volume (SV) and/or cardiac output monitoring because it requires lateral positioning, one-lung ventilation, and open-chest condition. Pulse contour analysis and esophageal Doppler have been proposed with contrasting results, whereas dynamic indices have been shown useless for predicting fluid responsiveness in that specific setting. Besides, more invasive technologies like thermodilution are not routinely used at the bedside by careproviders.

Chest bioreactance seems to be a feasible, safe, rustic, easy-to-use, and plug-and-play method to non-invasively and continuously monitor SV and cardiac output in thoracic cancer surgery patients, able to detect significant spontaneous and pharmacologically-induced changes over time. The impact of chest bioreactance on patients 'outcome remains however to be demonstrated.

Indeed, the routine fluid management in patients undergoing lung resection surgery could be responsible of hypovolemia/hypoperfusion and/or hypervolemia/congestion leading to postoperative complications.

The present national prospective multicenter randomized simple blind study aims to demonstrate that an individualized goal-directed fluid therapy (GDFT) driven by chest bioreactance improves outcomes within 30 days in lung resection surgery patients when compared with a standard of care. As double blind is not possible, an adjudication committee, whose members will be unaware of the procedure assignments, will adjudicate all the clinical outcomes.

Detailed Description

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Conditions

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High-risk Lung Resection Surgery

Keywords

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goal-directed fluid therapy Chest bioreactance lung resection surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

National prospective multicenter randomized simple blind controlled study comparing a standard of care (control group) to an individualized strategy of intraoperative GDFT driven by non-invasive continuous SV monitoring via chest bioreactance (optimized group).
Primary Study Purpose

OTHER

Blinding Strategy

SINGLE

Participants
The patients are the only ones masked. As double blind is not possible, an adjudication committee, whose members will be unaware of the procedure assignments, will adjudicate all the clinical outcomes.

Study Groups

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Optimized group managed by the Starling device

In the optimized group, patients will be managed intraoperatively with the Starling device according to the Société Française d'Anesthésie Réanimation 2024 GDFT protocol (Alter C. https://sfar.org/optimisation-hemodynamique-perioperatoire-adulte-dont-obstetrique/). It is a non-invasive fluid management monitoring system provides continuous hemodynamic monitoring and empowers fluid management across the continuum of care. Thanks to this device, patients will be managed according to the following protocol: fluid responsiveness will be systematically assessed after anesthetic induction and throughout the procedure as soon as the basal SV monitored by the Starling device decrease by at least 10%. To do so, repetitive fluid challenges (200 ± 50 ml of cristalloids) will be quickly delivered until SV stops to increase by 10% or more. Vasoactive and/or inotropic agents will be used at the discretion of the attending anesthesiologists in case of fluid unresponsiveness.

Group Type EXPERIMENTAL

individualized goal-directed fluid therapy by Starling device

Intervention Type PROCEDURE

For patients in optimized group, fluids will be managed by Starling device during the lung resection surgery.

Control group managed by standard of care

In the control group, patients will be managed intraoperatively at the discretion of the attending anesthesiologists, in accordance with their institutional protocols (i.e. fluids and/or vasoactive agents are given to maintain mean arterial pressure ≥ 65 mmHg).

Group Type OTHER

group managed by standard of care

Intervention Type PROCEDURE

Patients will be managed intraoperatively at the discretion of the attending anesthesiologists, in accordance with their institutional protocols

Interventions

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individualized goal-directed fluid therapy by Starling device

For patients in optimized group, fluids will be managed by Starling device during the lung resection surgery.

Intervention Type PROCEDURE

group managed by standard of care

Patients will be managed intraoperatively at the discretion of the attending anesthesiologists, in accordance with their institutional protocols

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Adults (≥ 18 years old)
* High-risk patients (ASA score ≥ 3 and/or ventilatory deficit (defined as FEV1≤70% and/or VC≤70%) and/or AKI risk index ≥ III and/or modified clinical Lee Criteria ≥2) undergoing elective open-chest or video-assisted or robotic lung resection surgery
* Patients who have provided written informed consent to participate in the study
* Patients affiliated with a social health insurance

Exclusion Criteria

* Pleural or mediastinal resection surgery
* Emergency surgery (Less than 24h)
* Patients unable to understand the purpose of the study
* Patients participating in another trial that would interfere with this study
* Female patients who are pregnant, lactating or women of child-bearing potential without effective methods of contraception
* Female patients with positive β-HCG blood test
* Patients under judicial protection (guardianship, curatorship)
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospices Civils de Lyon

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Hopital Louis Pradel

Bron, , France

Site Status RECRUITING

CHU Dijon Bourgogne

Dijon, , France

Site Status RECRUITING

Hôpital Arnaud de Villeneuve - CHU Montpellier

Montpellier, , France

Site Status RECRUITING

Chu Nancy

Nancy, , France

Site Status RECRUITING

Hôpital Européen Georges Pompidou

Paris, , France

Site Status RECRUITING

Hopital du Haut-Leveque - CHU Bordeaux

Pessac, , France

Site Status RECRUITING

CHU de Rennes

Rennes, , France

Site Status RECRUITING

CHU Nantes

Saint-Herblain, , France

Site Status RECRUITING

CHU Strasbourg

Strasbourg, , France

Site Status RECRUITING

Chu Toulouse

Toulouse, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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FELLAHI Jean-Luc, M.D., Ph.D.,

Role: CONTACT

Phone: (+33) 4 72 11 89 33

Email: [email protected]

SAMSON Géraldine

Role: CONTACT

Phone: (+33) 4.27.85.53.26

Email: [email protected]

Facility Contacts

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FELLAHI Jean-Luc, MD. PhD

Role: primary

Guinot Pierre, MD

Role: primary

Godard Philippe, MD

Role: primary

GUERCI PHILIPPE

Role: primary

Bernard Cholley, MD

Role: primary

Ouattara Alexandre, MD

Role: primary

Nesseler Nicolas, MD

Role: primary

Bertrand Rozec, MD

Role: primary

Michel Mertes, MD

Role: primary

LABASTE François, MD

Role: primary

Other Identifiers

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2024-A01843-44

Identifier Type: OTHER

Identifier Source: secondary_id

69HCL22_1133

Identifier Type: -

Identifier Source: org_study_id