- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04231656
Pulse CONtour and BIoimpedance for Measurements of Stroke Volume During Changes in CARdiac Preload (ConBi-Car)
Stoke Volume Measurements During Changes in Cardiac Preload: Are Pulse Contour Analysis (CLEARSIGHT) and Transthoracic Bioelectrical Impedance (NICCOMO) Equivalent?
Fluid therapy guided by stroke volume response to repeated fluid challenges is used for hemodynamic optimization during general anesthesia. Two types of devices that measure stroke volume non-invasively are primarily available for intermediate-risk surgery under general anesthesia. They are based on two different techniques, (1) pulse contour analysis, and (2) transthoracic bioimpedance. They have never been compared with each other. Therefore, it is not known (1) whether they are interchangeable for the measurement of stroke volume changes (usually assessed as the "concordance" of two techniques), and (2) whether one is better than the other.
The aim is to study the concordance of these two non-invasive hemodynamic devices. it will use both of them in patients undergoing intermediate risk surgery. They will be tested during modifications of cardiac preload induced by Trendelenburg and anti-Trendelenburg positioning, as well as during intraoperative fluid challenges, vasopressor boluses and alveolar recruitment maneuvers.
Study Overview
Status
Conditions
Detailed Description
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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-
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Lille, France, 59037
- Hôpital Roger Salengro, CHU Lille
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Eligible and suitable for intermediate risk surgery, validated by anaesthesia consultation.
There is no definitive definition of intermediate risk. By reference to the literature, surgeries longer than 2 hours (excluding "low risk") and less than 3% postoperative mortality (excluding high-risk surgery). It includes the majority of non-serious visceral (abdominal and gynecological) surgery, plastic or cervical-facial surgery for neoplastic removal or long-term reconstruction, or long-term spinal surgery or neurosurgery of the base of the skull.
- For which the anesthesiologist in charge has planned an invasive monitoring (radial catheter) of arterial blood pressure.
Exclusion Criteria:
- Urgent surgery
- Intracranial hypertension
- Orthostatic hypotension
- Extreme anthropometry: weight >150 kg and 30 kg, size 120 cm and >230 cm
Related to NICCOMO monitoring:
- Rhythmic anomaly: Atrial fibrillation, tachycardia with heart rate >200 beats per minute.
- Aortic disease: Severe sclerosis
- Valve dysfunction: severe aortic regurgitation,
- Patient with aortic prosthesis or pacemaker using impedance detection.
- Occurrence of tachycardia > 200 bpm, occurrence of hypertension with mean arterial pressure >130 mm Hg
- Simultaneous use of electrical cauterization systems during surgical procedures
- Septic shock
Related to CLEARSIGHT monitoring
- Patient with prior distal perfusion disorders
- Lower extremity obliterans arteritis stage IV
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Sequence A before sequence B
Patients eligible for intermediate risk surgery requiring the placement of an invasive continuous blood pressure measurement device and stroke volume monitoring for fluid management.
Sequence A of positioning (before the procedure), and sequence B after the procedure.
|
Starting from 0° position, shift to position +20°, then tilt to -20°, and finally back to the 0° position.
Other Names:
Starting from 0° position, shift to position -20°, then tilt to +20°, and finally back to the 0° position and collect the last group of figures.
Other Names:
|
Experimental: Sequence B before sequence A
Patients eligible for intermediate risk surgery requiring the placement of an invasive continuous blood pressure measurement device and stroke volume monitoring for fluid management.
Sequence B of positioning before the procedure, and sequence A after the procedure.
|
Starting from 0° position, shift to position +20°, then tilt to -20°, and finally back to the 0° position.
Other Names:
Starting from 0° position, shift to position -20°, then tilt to +20°, and finally back to the 0° position and collect the last group of figures.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
concordance of stroke volume changes measured with each monitor during the standardized maneuvers of sequences A and B (total: 6 observations per individual).
Time Frame: during each changes of positioning (i.e., for 1-2 minutes in each condition, for a total of 10-15 minutes following initial measurements in basal conditions), during sequences A and B
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4-quadrant plot
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during each changes of positioning (i.e., for 1-2 minutes in each condition, for a total of 10-15 minutes following initial measurements in basal conditions), during sequences A and B
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Fluid responsiveness defined by areas under the Receiver Operating Characteristic curve (sensitivity and specificity)
Time Frame: during each changes of positioning (i.e., for 1-2 minutes in each condition, for a total of 10-15 minutes following initial measurements in basal conditions), during sequences A and B
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Comparison of areas under the Receiver Operating Characteristic curve (sensitivity and specificity).
Each maneuver will be classified as "responder" or "nonresponder" according to the value of Pulse Pressure Variation (PPV) recorded before the maneuver and to the changes in PPV during the maneuver (as previously published)
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during each changes of positioning (i.e., for 1-2 minutes in each condition, for a total of 10-15 minutes following initial measurements in basal conditions), during sequences A and B
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concordance of stroke volume changes measured with each monitor during the standardized maneuvers mimicking preload decrease.
Time Frame: during each changes of positioning where cardiac preload is supposed to decrease (i.e., for 1-2 minutes in one out of two condition, for a total of 10-15 minutes following initial measurements in basal conditions), during sequences A and B
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4-quadrant plot
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during each changes of positioning where cardiac preload is supposed to decrease (i.e., for 1-2 minutes in one out of two condition, for a total of 10-15 minutes following initial measurements in basal conditions), during sequences A and B
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concordance of stroke volume changes measured with each monitor during the standardized maneuver mimicking preload increase.
Time Frame: during each changes of positioning where cardiac preload is supposed to increase (i.e., for 1-2 minutes in one out of two condition, for a total of 10-15 minutes following initial measurements in basal conditions), during sequences A and B
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4-quadrant plot
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during each changes of positioning where cardiac preload is supposed to increase (i.e., for 1-2 minutes in one out of two condition, for a total of 10-15 minutes following initial measurements in basal conditions), during sequences A and B
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concordance of stroke volume changes measured with each monitor during the surgical procedure (fluid challenges, vasopressor boluses, alveolar recruitment maneuver).
Time Frame: throughout surgery (mean length expected between 3 and 5 hours). Measurements performed during sequences of 5-20 minutes that can occur several times during surgery
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4-quadrant plot
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throughout surgery (mean length expected between 3 and 5 hours). Measurements performed during sequences of 5-20 minutes that can occur several times during surgery
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interchangeability of stroke volume measurements with each monitor during sequences A and B
Time Frame: before and after each changes of positioning (i.e., for 1-2 minutes in each condition, for a total of 10-15 minutes following initial measurements in basal conditions), during sequences A and B
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Bland and Altman plot for repeated measures
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before and after each changes of positioning (i.e., for 1-2 minutes in each condition, for a total of 10-15 minutes following initial measurements in basal conditions), during sequences A and B
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interchangeability of stroke volume measured with each monitor during the surgical procedure (fluid challenges, vasopressor boluses, alveolar recruitment maneuver).
Time Frame: throughout surgery (mean length expected between 3 and 5 hours). Measurements performed before and after sequences of 5-20 minutes that can occur several times during surgery
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Bland and Altman plot for repeated measures
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throughout surgery (mean length expected between 3 and 5 hours). Measurements performed before and after sequences of 5-20 minutes that can occur several times during surgery
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concordance of stroke volume changes measured with each monitor with that measured by a Vigileo/Flotrac monitor during the standardized maneuvers of sequences A and B (total: 6 observations per individual).
Time Frame: during each changes of positioning (i.e., for 1-2 minutes in each condition, for a total of 10-15 minutes following initial measurements in basal conditions), during sequences A and B
|
4-quadrant plot
|
during each changes of positioning (i.e., for 1-2 minutes in each condition, for a total of 10-15 minutes following initial measurements in basal conditions), during sequences A and B
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Benoit Tavernier, MD,PhD, University Hospital Lille, France
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
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
Keywords
Other Study ID Numbers
- 2019_46
- 2019-A02697-50 (Other Identifier: ID-RCB number, ANSM)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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