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)
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
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Mohammad Elhossieny Salama, MD
- Telefonnummer: +201016865861
- E-mail: MohammadElhossieny88@med.suez.edu.eg
Undersøgelse Kontakt Backup
- Navn: Mahmoud Hosny Ahmed, MD
- Telefonnummer: +201097920831
- E-mail: M.hosnawy@med.suez.edu.eg
Studiesteder
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Ismailia Governorate
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Ismailia, Ismailia Governorate, Egypten, 41522
- Suez Canal University hospitals
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Kontakt:
- Muhammad Elhossieny Salama, MD
- Telefonnummer: 01016865861
- E-mail: mohammadelhossieny88@med.suez.edu.eg
-
Ledende efterforsker:
- Muhammad Elhossieny Salama, MD
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Underforsker:
- Mahmoud Hosny Ahmed, MD
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
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.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Firedobbelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
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Eksperimentel: 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.
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Continuous norepinephrine infusion administered at a fixed dose of 0.03 µg/kg/min from induction of anesthesia until skin closure.
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Placebo komparator: 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.
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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.
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Total intraoperative crystalloid administration
Tidsramme: From induction of anesthesia until skin closure (intraoperative period)
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Total volume of crystalloid administered intraoperatively from induction of anesthesia until skin closure, measured in milliliters.
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From induction of anesthesia until skin closure (intraoperative period)
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Lactate Levels
Tidsramme: After induction of anesthesia, at the end of surgery, and 24 hours postoperatively
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Arterial lactate concentration measured in mmol/L serially during the perioperative period
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After induction of anesthesia, at the end of surgery, and 24 hours postoperatively
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Urine Output
Tidsramme: From induction of anesthesia until skin closure (Intraoperative period)
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Hourly intraoperative urine output measured from urinary catheter collection and expressed as total mL/kg/hour.
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From induction of anesthesia until skin closure (Intraoperative period)
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Intraoperative Blood Loss
Tidsramme: From surgical incision until skin closure (Intraoperative period)
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Estimated intraoperative blood loss measured in milliliters using suction canister volume after subtraction of irrigation fluids in addition to surgical field assessment.
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From surgical incision until skin closure (Intraoperative period)
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Number of Participants with Postoperative Pulmonary Complications
Tidsramme: Within seven postoperative days
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Incidence of postoperative pulmonary complications defined according to European Perioperative Clinical Outcome (EPCO) criteria using clinical, radiological, and laboratory findings
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Within seven postoperative days
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Number of Participants With Acute Kidney Injury
Tidsramme: Within seven postoperative days
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Incidence of acute kidney injury defined according to KDIGO criteria based on serum creatinine changes and urine output.
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Within seven postoperative days
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Duration of Rescue Norepinephrine Requirement
Tidsramme: From induction of anesthesia until skin closure (Intraoperative period)
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Cumulative duration of rescue open-label norepinephrine infusion for persistent hemodynamic instability measured in minutes.
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From induction of anesthesia until skin closure (Intraoperative period)
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Duration of Intraoperative Hypotension
Tidsramme: From induction of anesthesia until skin closure (Intraoperative period)
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Cumulative duration of intraoperative hypotension defined as mean arterial pressure below 65 mmHg, measured in minutes using nvasive arterial blood pressure monitoring.
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From induction of anesthesia until skin closure (Intraoperative period)
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Number of Participants Admitted to the Intensive Care Unit
Tidsramme: Within seven postoperative days
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Number of participants requiring admission to the intensive care unit during the postoperative period.
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Within seven postoperative days
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Duration of Postoperative Hospital Stay
Tidsramme: Within seven postoperative days
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Total postoperative hospital stay measured in days during the first seven postoperative days
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Within seven postoperative days
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Number of Participants With Postoperative Surgical Complications
Tidsramme: Within seven postoperative days
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Incidence of postoperative surgical complications assessed according to Clavien-Dindo classification grade II or higher during the first seven postoperative days.
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Within seven postoperative days
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Publikationer og nyttige links
Generelle publikationer
- Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, Christophi C, Leslie K, McGuinness S, Parke R, Serpell J, Chan MTV, Painter T, McCluskey S, Minto G, Wallace S; Australian and New Zealand College of Anaesthetists Clinical Trials Network and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery. N Engl J Med. 2018 Jun 14;378(24):2263-2274. doi: 10.1056/NEJMoa1801601. Epub 2018 May 9.
- Cecconi M, Hofer C, Teboul JL, Pettila V, Wilkman E, Molnar Z, Della Rocca G, Aldecoa C, Artigas A, Jog S, Sander M, Spies C, Lefrant JY, De Backer D; FENICE Investigators; ESICM Trial Group. Fluid challenges in intensive care: the FENICE study: A global inception cohort study. Intensive Care Med. 2015 Sep;41(9):1529-37. doi: 10.1007/s00134-015-3850-x. Epub 2015 Jul 11.
- Persichini R, Lai C, Teboul JL, Adda I, Guerin L, Monnet X. Venous return and mean systemic filling pressure: physiology and clinical applications. Crit Care. 2022 May 24;26(1):150. doi: 10.1186/s13054-022-04024-x.
- Felippe VA, Codeceira R, Irigaray M, Sckaff M, Wegner B, Nascimento T, Darcy C, Dutra L, Santiago B, Buchmann J, Lessa MA. Non-invasive goal-directed fluid therapy with the pleth variability index (PVI): a systematic review and meta-analysis. J Clin Monit Comput. 2025 Oct;39(5):917-927. doi: 10.1007/s10877-025-01334-7. Epub 2025 Aug 8.
- Canet J, Gallart L, Gomar C, Paluzie G, Valles J, Castillo J, Sabate S, Mazo V, Briones Z, Sanchis J; ARISCAT Group. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010 Dec;113(6):1338-50. doi: 10.1097/ALN.0b013e3181fc6e0a.
- Cannesson M, Le Manach Y, Hofer CK, Goarin JP, Lehot JJ, Vallet B, Tavernier B. Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a "gray zone" approach. Anesthesiology. 2011 Aug;115(2):231-41. doi: 10.1097/ALN.0b013e318225b80a.
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- 6476# (Registry Identifier: Research Ethics Committee, Faculty of Medicine, Suez Canal University)
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
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