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Noradrenalin til behandling af generel anæstesi-induceret arteriel hypotension hos patienter med kronisk hjertesvigt (NORAFLOW)

4. november 2026 opdateret af: University Hospital, Toulouse

Evaluering af noradrenalin i behandlingen af ​​generel anæstesi-induceret arteriel hypotension hos patienter med kronisk hjertesvigt i operationsstuen.

Arterial hypotension is a frequent complication of general anesthesia and a significant contributor to postoperative complications. It is a critical marker for the development of acute renal failure and postoperative myocardial infarction. Chronic heart failure (CHF) patients are increasingly encountered in the operating room, and their perioperative morbidity and mortality are substantial, with specific management lacking precise recommendations.

The main objective is to assess the impact of a diluted norepinephrine bolus on cardiac output in chronic heart failure patients experiencing arterial hypotension after anesthesia induction.

Studieoversigt

Status

Rekruttering

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Arterial hypotension is a frequent complication of general anesthesia and a significant contributor to postoperative complications. It is a critical marker for the development of acute renal failure and postoperative myocardial infarction. Chronic heart failure (CHF) patients are increasingly encountered in the operating room, and their perioperative morbidity and mortality are substantial, with specific management lacking precise recommendations. The potential indications for norepinephrine use are expanding due to dilution methods allowing peripheral catheter administration, particularly for addressing arterial hypotension during general anesthesia induction. However, these indications are primarily based on common practices, and the impact of norepinephrine on cardiac output in patients with chronic heart failure is poorly understood. The main objective is to assess the impact of a diluted norepinephrine bolus on cardiac output in chronic heart failure patients experiencing arterial hypotension after anesthesia induction.

Undersøgelsestype

Observationel

Tilmelding (Anslået)

50

Kontakter og lokationer

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Studiekontakt

Studiesteder

      • Toulouse, Frankrig, 31400
        • Rekruttering
        • CHU Toulouse Rangueil
        • Kontakt:

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Prøveudtagningsmetode

Ikke-sandsynlighedsprøve

Studiebefolkning

The study population includes patients with heart failure and left ventricular failure with a ventricular ejection fraction less than or equal to 40%.

Beskrivelse

Inclusion Criteria:

  • Adult patients
  • Heart failure patients with left ventricular failure with a ventricular ejection fraction less than or equal to 40% evaluated by trans-thoracic echocardiography less than a year ago and specifying in particular the patient's filling pressures at the state stable.
  • Patients under treatment adapted to the level of heart failure according to the 2021 European Society of Cardiology recommendations.
  • Scheduled surgery under general anesthesia.
  • Invasive hemodynamic monitoring planned by the anesthetist-resuscitator (irrespective of potential inclusion in the protocol): arterial catheter and central venous line for measurement of CVP (central venous pressure).
  • Postoperative monitoring planned in intensive care or intensive care
  • Presence of controlled mechanical ventilation with tidal volumes between 8 and 10 ml/kg of ideal weight.
  • Presence of arterial hypotension after induction of general anesthesia, and before surgical stimulation.
  • Patient affiliated to a social security scheme or equivalent
  • No opposition from the patient.

Exclusion Criteria:

  • Chronic heart failure patients with right ventricular failure.
  • Patients presenting signs of acute pulmonary edema, Pulmonary arterial hypertension (PAH), severe valvular disease, intracardiac shunt.
  • Patients operated on under general anesthesia but maintaining spontaneous ventilation.
  • Patients with respiratory compliance disorders with compliances greater than 30 cm of water.
  • Patients with intra-abdominal hypertension.
  • Patients with supraventricular or ventricular arrhythmia.
  • Patients treated with catecholamines prior to the procedure.
  • Patients operated on for urgent surgeries
  • Patient under guardianship, curatorship or safeguard of justice
  • Pregnant or breastfeeding women.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Observationsmodeller: COHORT
  • Tidsperspektiver: PROSPECTIVE

Kohorter og interventioner

Gruppe / kohorte
Intervention / Behandling
Research procedures

Patients with heart failure

During the surgery, the channels and monitoring equipment will be set up according to the usual procedure in the vascular surgery department. As part of the research, the Starling™ SV Sebac® electrodes will be installed (to measure cardiac flow, cardiac index (CI), stroke volume (VES), variations in stroke volume (VVES), and peripheral resistors (TPRI)).

Once the equipment is in place, anesthetic induction will be carried out according to the usual protocol with curarization and mechanical ventilation.

If the appearance of arterial hypotension is noted after anesthetic induction and mechanical ventilation, the patient will be definitively included in the study. As recommended, he will receive norepinephrine to treat hypotension.

The measurements from the monitoring will be collected at 3, 5, and 10 min after the administration of norepinephrine.

10 days after admission to the operating room, hospitalization data will be collected.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Evaluation of the impact of a bolus of diluted norepinephrine on cardiac output in chronic heart failure patients presenting with arterial hypotension after anesthetic induction.
Tidsramme: During the surgery.

The evolution of the value of cardiac output assessed by non-invasive monitoring, using bioreactance: Starling™ SV Sebac®.

During the surgery.

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Evaluation of the role of preload dependence before anesthetic induction in the variation of cardiac output after a norepinephrine bolus.
Tidsramme: During the surgery.

Measurement of pulse pressure difference.

During the surgery.
Evaluation of the impact of the norepinephrine bolus on blood pressure correction.
Tidsramme: During the surgery.

Evolution of the monitoring data: systolic blood pressure (SBP - mmHg).

During the surgery.
Evaluation of the impact of the norepinephrine bolus on heart rate.
Tidsramme: During the surgery.

Evolution of the monitoring data: heart rate (HR - bpm).

During the surgery.
Evaluation of the safety of use of norepinephrine in chronic heart failure patients during hospitalization.
Tidsramme: For 10 days after surgery.

Monitoring the appearance of side effects during post-operative hospitalization on the assessments usually carried out in the department and including.

For 10 days after surgery.

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Efterforskere

  • Ledende efterforsker: François LABASTE, Dr, University Hospital, Toulouse

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

17. oktober 2024

Primær færdiggørelse (Anslået)

1. december 2026

Studieafslutning (Anslået)

1. december 2026

Datoer for studieregistrering

Først indsendt

28. marts 2024

Først indsendt, der opfyldte QC-kriterier

4. april 2024

Først opslået (Faktiske)

8. april 2024

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

5. november 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

4. november 2026

Sidst verificeret

1. november 2026

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • RC31/24/0017

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