- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02060942
Mean Systemic Filling Pressure and Heart Performance Predicting Fluid Responsiveness
May 18, 2016 updated by: L.P.B. Meijs, Catharina Ziekenhuis Eindhoven
Mean Systemic Filling Pressure and Heart Performance as Predictors of Successful Fluid Responsiveness in Patients With Coronary Artery Bypass Grafting
Determining fluid responsiveness in critically ill patients by measuring mean systemic filling pressure on the intensive care unit.
Study Overview
Status
Completed
Conditions
Detailed Description
The assessment of the cardiovascular state in critically ill patients is subject to difficulties in terms of the fact that several hemodynamic parameters, for example mean arterial blood pressure (MAP) and cardiac output (CO) supply insufficient information about the circulating volume and cardiac performance.
There is a clinical need to adequate determination of intravascular volume status and therefore reliable predictors of fluid responsiveness are highly relevant.
However, in determining the fluid status of a patient, the lack of appreciation of the venous side of the circulation persists today, which is greatly due to the inability to appropriately assess the venous side of the circulation.
The importance of the venous part of the circulation is moreover reflected by the fact that an increase in venous resistance does reduce CO many times more than a similar increase in arterial resistance.
Mean systemic filling pressure (Pms), which is defined as the pressure equal to the pressure which would be measured if the heart should suddenly stop pumping and all (arterial and venous) the pressures in the entire circulatory system should be brought to equilibrium instantaneously, is a good, complete and reliable reflection of the total intravascular fluid compartment.
Passive leg raising (PLR) represents a "self-volume challenge" that predicts preload responsiveness and the transient hemodynamic changes on venous return can be directly monitored in ventilated patients, provided that there is an intact circulation, in order to test the amount of volume responsiveness.
Study Type
Observational
Enrollment (Actual)
40
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
North Brabant
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Eindhoven, North Brabant, Netherlands, 5623 EJ
- Catharina Hospital
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-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (ADULT, OLDER_ADULT)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Sampling Method
Probability Sample
Study Population
Coronary artery bypass grafting, aortic valve replacement and septic shock patients
Description
Inclusion Criteria:
- Patients must be older than 18 years, and must be equipped with a pulse-contour cardiac output system with a central venous catheter. Patients will be subsequently connected to the hemodynamic monitoring device Navigator™. In those patients with clinical signs of inadequate tissue perfusion, passive leg raising and standardized fluid challenge will be performed.
Exclusion Criteria:
- Patients with assist devices (e.g. intra aortic balloon pump, Impella®, ECMO), patients with arrhythmias (either atrial of ventricular) will be excluded from the study. Also, patients with inguinal impairment or contraindications for a passive leg raising will be excluded (such as deep venous thrombosis or elastic compression stocking), head trauma, an increase intra-abdominal pressure suspected by clinical context and examination as well as patients with absolute contraindications for fluid challenge.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
---|
Coronary artery bypass grafting
Post Anaesthetic Care Unit (PACU) patients treated with coronary artery bypass grafting (CABG) are highly eligible for this study.
These are patients with an indication for fast track treatment (PACU) post-cardiac surgery with a good left ventricular ejection fraction without significant co-morbidity.
The final decision for PACU-classification is taken by the responsible anaesthesiologist and intensivist in close collaboration with the cardiothoracic surgeon performing the operation, as well as the cardiologist.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mean systemic filling pressure (Pms)
Time Frame: 1 hour
|
An increase in mean systemic filling pressure after (self)volume-challenge indicating volume responsiveness of the patient
|
1 hour
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Heart performance (eH)
Time Frame: 1 hour
|
Quotient of driving pressure of venous return in mmHg
|
1 hour
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Secondary hemodynamic parameters
Time Frame: 1 hour
|
Heart Rate
|
1 hour
|
Secondary hemodynamic parameters
Time Frame: 1 hour
|
Mean Arterial Blood Pressure
|
1 hour
|
Secondary hemodynamic parameters
Time Frame: 1 hour
|
Cardiac Index
|
1 hour
|
Secondary hemodynamic parameters
Time Frame: 1 hour
|
Central Venous Pressure
|
1 hour
|
Secondary hemodynamic parameters
Time Frame: 1 hour
|
Systemic Vascular Resistance
|
1 hour
|
Secondary hemodynamic parameters
Time Frame: 1 hour
|
Pulse Pressure Variation
|
1 hour
|
Secondary hemodynamic parameters
Time Frame: 1 hour
|
Pulmonary Vascular Permeability Index
|
1 hour
|
Secondary hemodynamic parameters
Time Frame: 1 hour
|
Plethysmographic Oxygen Saturation
|
1 hour
|
Secondary hemodynamic parameters
Time Frame: 1 hour
|
Delivery of Oxygen Index
|
1 hour
|
Secondary hemodynamic parameters
Time Frame: 1 hour
|
Mechanical Ventilation Settings
|
1 hour
|
Secondary hemodynamic parameters
Time Frame: 1 hour
|
End-tidal CO2
|
1 hour
|
Secondary hemodynamic parameters
Time Frame: 1 hour
|
Peripheral Temperature
|
1 hour
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Study Chair: Jan Bakker, PhD, Erasmus University Hospital Rotterdam The Netherlands
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Maas JJ, Geerts BF, van den Berg PC, Pinsky MR, Jansen JR. Assessment of venous return curve and mean systemic filling pressure in postoperative cardiac surgery patients. Crit Care Med. 2009 Mar;37(3):912-8. doi: 10.1097/CCM.0b013e3181961481.
- Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, Teboul JL. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med. 2006 May;34(5):1402-7. doi: 10.1097/01.CCM.0000215453.11735.06.
- Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ; Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005 Dec;18(12):1440-63. doi: 10.1016/j.echo.2005.10.005. No abstract available.
- Jolly SS, Yusuf S, Cairns J, Niemela K, Xavier D, Widimsky P, Budaj A, Niemela M, Valentin V, Lewis BS, Avezum A, Steg PG, Rao SV, Gao P, Afzal R, Joyner CD, Chrolavicius S, Mehta SR; RIVAL trial group. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011 Apr 23;377(9775):1409-20. doi: 10.1016/S0140-6736(11)60404-2. Epub 2011 Apr 4. Erratum In: Lancet. 2011 Apr 23;377(9775):1408. Lancet. 2011 Jul 2;378(9785):30.
- Parkin WG, Leaning MS. Therapeutic control of the circulation. J Clin Monit Comput. 2008 Dec;22(6):391-400. doi: 10.1007/s10877-008-9147-7. Epub 2008 Nov 12.
- Lansdorp B, Lemson J, van Putten MJ, de Keijzer A, van der Hoeven JG, Pickkers P. Dynamic indices do not predict volume responsiveness in routine clinical practice. Br J Anaesth. 2012 Mar;108(3):395-401. doi: 10.1093/bja/aer411. Epub 2011 Dec 20.
- Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest. 2002 Jun;121(6):2000-8. doi: 10.1378/chest.121.6.2000.
- Keller G, Desebbe O, Benard M, Bouchet JB, Lehot JJ. Bedside assessment of passive leg raising effects on venous return. J Clin Monit Comput. 2011 Aug;25(4):257-63. doi: 10.1007/s10877-011-9303-3. Epub 2011 Sep 24.
- Anderson RM, Fritz JM, O'Hare JE. The mechanical nature of the heart as a pump. Am Heart J. 1967 Jan;73(1):92-105. doi: 10.1016/0002-8703(67)90313-4. No abstract available.
- Rothe CF. Mean circulatory filling pressure: its meaning and measurement. J Appl Physiol (1985). 1993 Feb;74(2):499-509. doi: 10.1152/jappl.1993.74.2.499.
- GUYTON AC, ABERNATHY B, LANGSTON JB, KAUFMANN BN, FAIRCHILD HM. Relative importance of venous and arterial resistances in controlling venous return and cardiac output. Am J Physiol. 1959 May;196(5):1008-14. doi: 10.1152/ajplegacy.1959.196.5.1008. No abstract available.
- GUYTON AC, POLIZO D, ARMSTRONG GG. Mean circulatory filling pressure measured immediately after cessation of heart pumping. Am J Physiol. 1954 Nov;179(2):261-7. doi: 10.1152/ajplegacy.1954.179.2.261. No abstract available.
- GUYTON AC, LINDSEY AW, KAUFMANN BN. Effect of mean circulatory filling pressure and other peripheral circulatory factors on cardiac output. Am J Physiol. 1955 Mar;180(3):463-8. doi: 10.1152/ajplegacy.1955.180.3.463. No abstract available.
- GUYTON AC, LINDSEY AW, ABERNATHY B, RICHARDSON T. Venous return at various right atrial pressures and the normal venous return curve. Am J Physiol. 1957 Jun;189(3):609-15. doi: 10.1152/ajplegacy.1957.189.3.609. No abstract available.
- Parkin WG. Volume state control - a new approach. Crit Care Resusc. 1999 Sep;1(3):311-21.
- Pellegrino VA, Mudaliar Y, Gopalakrishnan M, Horton MD, Killick CJ, Parkin WG, Playford HR, Raper RF. Computer based haemodynamic guidance system is effective and safe in management of postoperative cardiac surgery patients. Anaesth Intensive Care. 2011 Mar;39(2):191-201. doi: 10.1177/0310057X1103900207.
- Jansen JR, Maas JJ, Pinsky MR. Bedside assessment of mean systemic filling pressure. Curr Opin Crit Care. 2010 Jun;16(3):231-6. doi: 10.1097/MCC.0b013e3283378185.
- Maas JJ, Pinsky MR, Geerts BF, de Wilde RB, Jansen JR. Estimation of mean systemic filling pressure in postoperative cardiac surgery patients with three methods. Intensive Care Med. 2012 Sep;38(9):1452-60. doi: 10.1007/s00134-012-2586-0. Epub 2012 May 15. Erratum In: Intensive Care Med. 2013 Jan;39(1):163.
- Oren-Grinberg A. The PiCCO Monitor. Int Anesthesiol Clin. 2010 Winter;48(1):57-85. doi: 10.1097/AIA.0b013e3181c3dc11. No abstract available.
- Bakker J, Damen J, van Zanten AR, Hubben JH; Protocollencommissie Nederlandse Vereiniging voor Intensive Care. [Admission and discharge criteria for intensive care departments]. Ned Tijdschr Geneeskd. 2003 Jan 18;147(3):110-5. Dutch.
- Jabot J, Teboul JL, Richard C, Monnet X. Passive leg raising for predicting fluid responsiveness: importance of the postural change. Intensive Care Med. 2009 Jan;35(1):85-90. doi: 10.1007/s00134-008-1293-3. Epub 2008 Sep 16.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
August 1, 2013
Primary Completion (ACTUAL)
January 1, 2015
Study Completion (ACTUAL)
January 1, 2015
Study Registration Dates
First Submitted
August 23, 2013
First Submitted That Met QC Criteria
February 11, 2014
First Posted (ESTIMATE)
February 12, 2014
Study Record Updates
Last Update Posted (ESTIMATE)
May 19, 2016
Last Update Submitted That Met QC Criteria
May 18, 2016
Last Verified
May 1, 2016
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- M12-1271
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
IPD Plan Description
No, data remain anonymized within hospital and property of PI.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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