- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04655885
Cardiac Output Optimization on Postoperative Complications in Major Hepatic Surgery (OPTILIVER)
Effect of an Individualized Protocol Based on Cardiac Output Optimization Guided by Dynamic Indices of Preload Responsiveness Monitoring on Postoperative Complications in Major Hepatic Surgery for Primary or Secondary Liver Cancer
Major hepatectomies are high-risk surgeries offered more and more frequently for the curative treatment of primary or secondary liver cancer, and for complex cases, representing a real challenge for medical teams. The 1st peroperative phase of "hepatic resection" requires a minimum supply of filling fluids to limit perioperative bleeding (Low Central Venous Pressure). However this strategy exposes the risk of organ hypoperfusion due to low cardiac flow, secondary to hypovolaemia, which may lead to ischemic situations favoring the onset of postoperative complications. On the other hand, the hemodynamic management of the 2nd peroperative phase "post hepatic resection" is marked by the need to correct this hypoperfusion by optimizing cardiac output by suitable vascular filling.
The major challenge is thus to restore cardiac output by refilling without excess, by correcting the hypovolemia that arose during the "post resection of the hepatic parenchyma" phase.
Our hypothesis is that an individualized protocol for optimizing intraoperative cardiac flow by guided vascular filling during the "post hepatic resection" phase is accompanied by a reduction in postoperative complications in patients operated on for major hepatic surgery.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Carine Feuillet, PhD
- Phone Number: +33 4 91 22 34 48
- Email: drci.up@ipc.unicancer.fr
Study Contact Backup
- Name: Dominique GENRE, MD
- Phone Number: +33 4 91 22 37 78
- Email: drci.up@ipc.unicancer.fr
Study Locations
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-
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Marseille, France, 13009
- Recruiting
- Institut Paoli Calmettes
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Contact:
- GOUARNE Caroline, PhD
- Phone Number: + 33 4 91 22 37 78
- Email: drci.up@ipc.unicancer.fr
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Contact:
- GENRE Dominique, MD
- Phone Number: + 33 4 91 22 37 78
- Email: drci.up@ipc.unicancer.fr
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age ≥ 18 years old,
- Signature of consent,
- Any patient scheduled for major hepatic surgery (≥ 3 segments) scheduled by laparotomy, for primary hepatic cancer or secondary metastases,
- Affiliation to the ''National security'' regimen or beneficiary of this regimen.
Exclusion Criteria:
- Emergency surgery,
- Cirrhosis: depending on availability of CT and / or MRI imaging results, clinical examination, Biology (PT, Bilirubin) or histological results (preoperative biopsies in healthy liver)
- Portal hypertension: depending on availability of imaging data, history of esophageal varices
- Contraindication to fitting a tool for monitoring dynamic hemodynamic indices (case of esophageal varices for esophageal Doppler for example),
- Benign tumors,
- Associated procedures programmed at the same operating time (excluding hepatic surgery): programmed associated digestive resection (colorectal or pancreatic),
- Laparoscopy,
- Liver transplantation,
- Woman pregnant or likely to be (without effective contraception) or breastfeeding,
- Person in an emergency situation, adult person subject to a legal protection measure (adult under guardianship, guardianship or legal protection), or unable to express consent,
- Inability to undergo medical monitoring of the trial for geographical, social or psychological reasons.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Optimization of cardiac flow by base water-electrolyte supply
Optimization of cardiac flow by base water-electrolyte supply of 1 ml / kg / h by Ringer Lactate® and faced with any decrease of more than 10% of the VES compared to the reference VES, achievement of an optimization of the preload by administration of 250 ml of Ringer Lactate® with renewal until correction of the VES.
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optimization of cardiac flow by base water-electrolyte supply of 1 ml / kg / h by Ringer Lactate® and faced with any decrease of more than 10% of the VES compared to the reference VES, achievement of an optimization of the preload by administration of 250 ml of Ringer Lactate® with renewal until correction of the VES.
|
Other: Control arm
Increase basic hydro-electrolyte supply of 6 ml / kg / h by Ringer Lactate® and 1: 1 blood loss compensation by crystalloids of the same nature.
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increase basic hydro-electrolyte supply of 6 ml / kg / h by Ringer Lactate® and 1: 1 blood loss compensation by crystalloids of the same nature.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Evaluation of the cardiac output optimization strategy on the occurrence of postoperative complications
Time Frame: From Day 1 to Day 30 post-surgery
|
Assessment of the impact of an individualized protocol for optimizing perioperative cardiac flow guided by monitoring of dynamic indices of preload dependence during the post-hepatic resection phase on the occurrence of postoperative complications in major hepatic surgery, for primary hepatic cancer or metastatic origin.
We retain as the primary endpoint, the percentage of patients with at least one postoperative complication regardless of the grade in the Dindo-Clavien classification.
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From Day 1 to Day 30 post-surgery
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Evaluation of grade III-IV postoperative complication in the Dindo-Clavien classification
Time Frame: From Day 1 to Day 30 post-surgery
|
To determine whether the strategy for optimizing cardiac output guided by dynamic dependence preload indices is associated with a difference in the incidence of occurrence of at least one grade III-IV postoperative complication in the Dindo-Clavien classification
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From Day 1 to Day 30 post-surgery
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Evaluation of length of stay in the hospital
Time Frame: From Day 1 to Day 30 post-surgery
|
To determine whether the cardiac output optimization strategy guided by the dynamic dependence preload indices is associated with a difference in the length of stay in the Continuing Care Unit, intensive care unit or length of hospital stay or on re-hospitalization rates
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From Day 1 to Day 30 post-surgery
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Evaluation of mortality
Time Frame: On Day 1, Day 30 and Day 90 post-surgery
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To determine whether the cardiac output optimization strategy guided by the dynamic dependence preload indices is associated with a difference in mortality at D30 and D90
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On Day 1, Day 30 and Day 90 post-surgery
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Evaluation occurrence of organ failures
Time Frame: From Day 1 to Day 7 post-surgery
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To determine whether the cardiac output optimization strategy guided by dynamic dependence preload indices has an impact on the occurrence of organ failures, which will be evaluated by the SOFA score per device from Day 1 to Day 7 postoperatively
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From Day 1 to Day 7 post-surgery
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Evaluation of hemodynamic parameters
Time Frame: From Day 0 to Day 1 post-surgery
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To determine whether the cardiac output optimization strategy guided by dynamic dependence preload indices is associated with a difference on hemodynamic parameters
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From Day 0 to Day 1 post-surgery
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Jean-Manuel de Guibert, MD, Institut Paoli-Calmettes
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
- OPTILIVER TRIAL-IPC 2018-022
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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