- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03340116
Measurement of Blood Volume Loss During Burn Surgery
Measurement of Plasma Volume, RBC Volume, and Total Blood Volume Using Daxor Blood Volume Analyzer (BVA-100) in Burn Surgery Patients Pre-operatively and Post-operatively to Determine if Blood Loss During Burn Surgery is Primarily Due to Either Loss of RBC Volume or Hemodilution
Study Overview
Status
Conditions
Detailed Description
Burn surgery is associated with significant changes (reductions) in hematocrit. However, it is unclear whether these reductions are the result of hemodilution from non-red cell containing intraoperative transfusions or from loss of red blood cells. The investigators will be using the Daxor Blood Volume Analyzer (BVA-100), an FDA approved instrument that can measure total blood volume, plasma volume, and RBC volume using the indicator dilution technique. With this technique, a tracer substance (I-131 albumin) is mixed with an unknown volume. An identical amount of the tracer is mixed into a solution with a known volume. By comparing the concentration of the indicator between the known and unknown volumes, the investigators can determine the volume of the unknown volume (or in this case, the blood volume).
The investigators will be measuring the change in blood volume, plasma volume, and RBC volume from the pre-operative to the post-operative state after completion of burn surgery. We hypothesize that these reductions in hematocrit are primarily the result of hemodilution rather than blood loss and that there will be a statistically significant change in measured plasma volume from the pre-operative to the post-operative measurements.
Average plasma volume for male and female patients is 2950ml SD=590 ml. To detect a 10% increase in plasma volume from hemodilution with a power 0.80 and alpha error 0.05, a one tailed normal distribution t-test determines a sample size fifty. To account for a 10% data loss (technical difficulty, patient withdraw) a sample size of fifty-five would be required.
Fifty-five consecutive adult patients (18 years or older) having burn surgery will be enrolled. Patients with recognized coagulopathy will be excluded. The outcome variables included blood volume (BV, ml), plasma volume (PV, ml) and red blood cell volume (RBCV, ml). All three outcome variables will be measured at two time points; pre-surgery and post-surgery. The pre-surgery measurement will be collected precisely after induction of general anesthesia but prior to surgery start. The post-surgery measurement will be taken immediately after the operation and after all intraoperative red blood cell transfusions are complete. For those patients receiving blood transfusions in the operating room prior to all data collection points, the transfused RBC volume will be recorded and subtracted from the RBCV measured after the transfusion. Transfused RBCV will take into account Hct of 60% for pRBCs. Additional baseline information, including age (year), sex (male, female), weight (kg), and surgery type, will be collected. For the tracer dilution method, the following blood samples will be collected: a baseline (no radiation sample), a first sample 12 minutes after injection (after complete mixing in the blood volume) and additional samples every 6 minutes for at least three successive timed sample points. These multiple timed sample points produce a logarithmic curve of radiation over time, as only a small fraction of albumin leaves the blood volume into the interstitial space. The investigators will compare the pre-operative and post-operative blood volume, RBC volume, and plasma volume measurements to determine if the decrease in hematocrit associated with burn surgery is truly due to hemodilution or loss of RBC volume.
Study Type
Contacts and Locations
Study Locations
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Virginia
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Richmond, Virginia, United States, 23223
- Virginia Commonwealth University Medical Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Sustained thermal burn of a depth that is deep partial thickness to full thickness and requires operative management
- Burn excision must occur within one week of thermal injury
- Burn size between 10-50% of total body surface area
- Must survive initial resuscitation
- Must consent for blood product transfusion
- Male or non-pregnant female
Exclusion Criteria:
- Cause of burn other than thermal injury (ie electrical or chemical injury)
- Women who are nursing, pregnant, or think they may be pregnant
- Patients with recognized coagulopathy
Study Plan
How is the study designed?
Design Details
- Observational Models: Case-Control
- Time Perspectives: Prospective
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Pre-operative cohort
This cohort will have their total blood volume, RBC volume, and plasma volumes measured using the Daxor BVA-100 prior to any surgical intervention
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Measurement of RBC volume, plasma volume, and total blood volume using Daxor BVA-100
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Post-operative cohort
This cohort will consist of the same study participants in the pre-operative cohort.
The only difference is that this cohort will have their total blood volume, RBC volume, and plasma volumes measured using the Daxor BVA-100 AFTER burn surgery.
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Measurement of RBC volume, plasma volume, and total blood volume using Daxor BVA-100
Burn surgery including wound debridement, skin grafting
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in measured plasma volume
Time Frame: Pre-operative period after intubation, but before surgery start and post-operative period after surgery stop and after all intraoperative blood transfusions are complete
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Measured plasma volume using Daxor BVA-100
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Pre-operative period after intubation, but before surgery start and post-operative period after surgery stop and after all intraoperative blood transfusions are complete
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Change in measured RBC volume
Time Frame: Pre-operative period after intubation, but before surgery start and post-operative period after surgery stop and after all intraoperative blood transfusions are complete
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Measured RBC volume using Daxor BVA-100
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Pre-operative period after intubation, but before surgery start and post-operative period after surgery stop and after all intraoperative blood transfusions are complete
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Change in measured total blood volume
Time Frame: Pre-operative period after intubation, but before surgery start and post-operative period after surgery stop and after all intraoperative blood transfusions are complete
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Measured total blood volume using Daxor BVA-100
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Pre-operative period after intubation, but before surgery start and post-operative period after surgery stop and after all intraoperative blood transfusions are complete
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Mark Nelson, MD, VCU Medical Center
- Principal Investigator: Michael Feldman, MD, VCU Medical Center
Publications and helpful links
General Publications
- Manzone TA, Dam HQ, Soltis D, Sagar VV. Blood volume analysis: a new technique and new clinical interest reinvigorate a classic study. J Nucl Med Technol. 2007 Jun;35(2):55-63; quiz 77, 79. doi: 10.2967/jnmt.106.035972. Epub 2007 May 11.
- Ong YS, Samuel M, Song C. Meta-analysis of early excision of burns. Burns. 2006 Mar;32(2):145-50. doi: 10.1016/j.burns.2005.09.005. Epub 2006 Jan 18.
- Budny PG, Regan PJ, Roberts AH. The estimation of blood loss during burns surgery. Burns. 1993 Apr;19(2):134-7. doi: 10.1016/0305-4179(93)90036-8.
- Meiser A, Casagranda O, Skipka G, Laubenthal H. [Quantification of blood loss. How precise is visual estimation and what does its accuracy depend on?]. Anaesthesist. 2001 Jan;50(1):13-20. doi: 10.1007/s001010050957. German.
- CRISPELL KR, PORTER B, NIESET RT. Studies of plasma volume using human serum albumin tagged with radioactive iodine. J Clin Invest. 1950 May;29(5):513-6. doi: 10.1172/JCI102288. No abstract available.
Helpful Links
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- HM20015231
- HM20011159 (Other Identifier: VCU IRB)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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