PRO STRESS Trial: Proactive Low-Dose Norepinephrine to Reduce Intraoperative Fluid Administration in Patients at High-Risk for Postoperative Pulmonary Complications Undergoing Laparoscopic Abdominal Surgery (PRO STRESS)

May 31, 2026 updated by: Suez Canal University

Proactive Low-Dose Norepinephrine to Reduce Intraoperative Fluid Administration in Patients at High-Risk for Postoperative Pulmonary Complications Undergoing Laparoscopic Abdominal Surgery: A Randomized Controlled Trial

Intraoperative hypotension is commonly treated with fluid administration; however, excessive fluid therapy may contribute to postoperative pulmonary complications. This randomized double-blind controlled trial evaluates whether proactive administration of fixed low-dose norepinephrine reduces intraoperative crystalloid administration while maintaining hemodynamic stability in high-risk patients undergoing laparoscopic abdominal surgery. One hundred and thirty patients will be randomized to receive either norepinephrine infusion (0.03 µg/kg/min) or placebo from induction until skin closure within a protocolized hemodynamic strategy guided by mean arterial pressure and pulse pressure variation.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

130

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Egypt
    • Ismailia Governorate
      • Ismailia, Ismailia Governorate, Egypt, 41522
        • Suez Canal University Hospitals
        • Contact:
        • Principal Investigator:
          • Muhammad Elhossieny Salama, MD
        • Sub-Investigator:
          • Mahmoud Hosny Ahmed, MD

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

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adult patients aged 18 years or older.
  • American Society of Anesthesiologists (ASA) physical status I-III.
  • Scheduled for elective laparoscopic major abdominal surgery under general anesthesia with an expected duration greater than 2 hours.
  • Patients with ARISCAT score ≥ 45 indicating high risk for postoperative pulmonary complications.

Exclusion Criteria:

  • Known hypersensitivity to norepinephrine.
  • Severe left ventricular dysfunction with ejection fraction < 35%.
  • Significant cardiac arrhythmia.
  • Uncontrolled hypertension defined as systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg.
  • End-stage renal disease.
  • Requirement for vasopressor support before induction of anesthesia.
  • Emergency surgery.

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

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Norepinephrine Group
Participants will receive continuous norepinephrine infusion at a fixed dose of 0.03 µg/kg/min initiated immediately after induction of anesthesia and continued until skin closure within a protocolized hemodynamic management strategy.
Drug: Norepinephrine
Continuous norepinephrine infusion administered at a fixed dose of 0.03 µg/kg/min from induction of anesthesia until skin closure.
Placebo Comparator: Control Group
Participants will receive an equivalent volume normal saline infusion initiated immediately after induction of anesthesia and continued until skin closure within the same protocolized hemodynamic management strategy.
Other: Placebo
Equivalent volume normal saline infusion administered from induction of anesthesia until skin closure at the same infusion rate as the active intervention to maintain blinding within a protocolized hemodynamic management strategy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Total intraoperative crystalloid administration
Time Frame: From induction of anesthesia until skin closure (intraoperative period)
Total volume of crystalloid administered intraoperatively from induction of anesthesia until skin closure, measured in milliliters.
From induction of anesthesia until skin closure (intraoperative period)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Postoperative Pulmonary Complications
Time Frame: Within seven postoperative days
Incidence of postoperative pulmonary complications defined according to European Perioperative Clinical Outcome (EPCO) criteria using clinical, radiological, and laboratory findings
Within seven postoperative days
Acute Kidney Injury
Time Frame: Within seven postoperative days
Incidence of acute kidney injury defined according to KDIGO criteria based on serum creatinine changes and urine output.
Within seven postoperative days
Lactate Levels
Time Frame: After induction of anesthesia, at the end of surgery, and 24 hours postoperatively
Arterial lactate concentration measured in mmol/L serially during the perioperative period
After induction of anesthesia, at the end of surgery, and 24 hours postoperatively
Urine Output
Time Frame: From induction of anesthesia until skin closure (Intraoperative period)
Hourly intraoperative urine output measured from urinary catheter collection and expressed as total mL/kg/hour.
From induction of anesthesia until skin closure (Intraoperative period)
Intraoperative Blood Loss
Time Frame: From surgical incision until skin closure (Intraoperative period)
Estimated intraoperative blood loss measured in milliliters using suction canister volume after subtraction of irrigation fluids in addition to surgical field assessment.
From surgical incision until skin closure (Intraoperative period)
Rescue Norepinephrine Requirement
Time Frame: From induction of anesthesia until skin closure (Intraoperative period)
Requirement for rescue open-label norepinephrine infusion for persistent hemodynamic instability including cumulative duration of infusion measured in minute
From induction of anesthesia until skin closure (Intraoperative period)
Duration of Intraoperative Hypotension
Time Frame: From induction of anesthesia until skin closure (Intraoperative period)
Cumulative duration of intraoperative hypotension defined as mean arterial pressure below 65 mmHg, measured in minutes and recorded from invasive arterial blood pressure monitoring.
From induction of anesthesia until skin closure (Intraoperative period)
Intensive Care Unit Admission
Time Frame: Within seven postoperative days
Admission to the intensive care unit during the postoperative period.
Within seven postoperative days
Length of Hospital Stay
Time Frame: Within seven postoperative days
Total postoperative hospital stay measured in days during the first seven postoperative days
Within seven postoperative days
Postoperative Surgical Complications
Time Frame: Within seven postoperative days
Incidence of postoperative surgical complications assessed according to Clavien-Dindo classification grade II or higher during the first seven postoperative days.
Within seven postoperative days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Suez Canal University

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

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 (Estimated)

May 23, 2026

Primary Completion (Estimated)

October 1, 2026

Study Completion (Estimated)

November 1, 2026

Study Registration Dates

First Submitted

May 31, 2026

First Submitted That Met QC Criteria

May 31, 2026

First Posted (Actual)

June 4, 2026

Study Record Updates

Last Update Posted (Actual)

June 4, 2026

Last Update Submitted That Met QC Criteria

May 31, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 6476# (Registry Identifier: Research Ethics Committee, Faculty of Medicine, Suez Canal University)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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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