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
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Studientyp
Studientyp
Einschreibung (Geschätzt)
Einschreibung
Phase
Phase
- Unzutreffend
Kontakte und Standorte
Studienkontakt
Studienkontakt
- Name: Mohammad Elhossieny Salama, MD
- Telefonnummer: +201016865861
- E-Mail: MohammadElhossieny88@med.suez.edu.eg
Studieren Sie die Kontaktsicherung
- Name: Mahmoud Hosny Ahmed, MD
- Telefonnummer: +201097920831
- E-Mail: M.hosnawy@med.suez.edu.eg
Studienorte
-
-
Ismailia Governorate
-
Ismailia, Ismailia Governorate, Ägypten, 41522
- Suez Canal University hospitals
-
Kontakt:
- Muhammad Elhossieny Salama, MD
- Telefonnummer: 01016865861
- E-Mail: mohammadelhossieny88@med.suez.edu.eg
-
Hauptermittler:
- Muhammad Elhossieny Salama, MD
-
Unterermittler:
- Mahmoud Hosny Ahmed, MD
-
-
Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
- Erwachsene
- Älterer Erwachsener
Akzeptiert gesunde Freiwillige
Beschreibung
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.
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Behandlung
- Zuteilung: Zufällig
- Interventionsmodell: Parallele Zuordnung
- Maskierung: Vervierfachen
Anzahl der Arme
Waffen und Interventionen
Teilnehmergruppe / ArmTeilnehmergruppe / Arm |
Intervention / BehandlungIntervention / Behandlung |
|---|---|
|
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.
|
Continuous norepinephrine infusion administered at a fixed dose of 0.03 µg/kg/min from induction of anesthesia until skin closure.
|
|
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.
|
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.
|
Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Total intraoperative crystalloid administration
Zeitfenster: 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)
|
Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Lactate Levels
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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)
|
|
Number of Participants with Postoperative Pulmonary Complications
Zeitfenster: 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
|
|
Number of Participants With Acute Kidney Injury
Zeitfenster: 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
|
|
Duration of Rescue Norepinephrine Requirement
Zeitfenster: From induction of anesthesia until skin closure (Intraoperative period)
|
Cumulative duration of rescue open-label norepinephrine infusion for persistent hemodynamic instability measured in minutes.
|
From induction of anesthesia until skin closure (Intraoperative period)
|
|
Duration of Intraoperative Hypotension
Zeitfenster: 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 using nvasive arterial blood pressure monitoring.
|
From induction of anesthesia until skin closure (Intraoperative period)
|
|
Number of Participants Admitted to the Intensive Care Unit
Zeitfenster: Within seven postoperative days
|
Number of participants requiring admission to the intensive care unit during the postoperative period.
|
Within seven postoperative days
|
|
Duration of Postoperative Hospital Stay
Zeitfenster: Within seven postoperative days
|
Total postoperative hospital stay measured in days during the first seven postoperative days
|
Within seven postoperative days
|
|
Number of Participants With Postoperative Surgical Complications
Zeitfenster: 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
|
Mitarbeiter und Ermittler
Sponsor
Sponsor
Publikationen und hilfreiche Links
Allgemeine Veröffentlichungen
- 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.
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Geschätzt)
Studienbeginn
Primärer Abschluss (Geschätzt)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- 6476# (Registrierungskennung: Research Ethics Committee, Faculty of Medicine, Suez Canal University)
Plan für individuelle Teilnehmerdaten (IPD)
Planen Sie, individuelle Teilnehmerdaten (IPD) zu teilen?
Arzneimittel- und Geräteinformationen, Studienunterlagen
Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt
Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt
Diese Informationen wurden ohne Änderungen direkt von der Website clinicaltrials.gov abgerufen. Wenn Sie Ihre Studiendaten ändern, entfernen oder aktualisieren möchten, wenden Sie sich bitte an register@clinicaltrials.gov. Sobald eine Änderung auf clinicaltrials.gov implementiert wird, wird diese automatisch auch auf unserer Website aktualisiert .