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
Descripción general del estudio
Estado
Estado
Condiciones
Condiciones
Intervención / Tratamiento
Intervención / Tratamiento
Tipo de estudio
Tipo de estudio
Inscripción (Estimado)
Inscripción
Fase
Fase
- No aplica
Contactos y Ubicaciones
Estudio Contacto
Estudio Contacto
- Nombre: Mohammad Elhossieny Salama, MD
- Número de teléfono: +201016865861
- Correo electrónico: MohammadElhossieny88@med.suez.edu.eg
Copia de seguridad de contactos de estudio
- Nombre: Mahmoud Hosny Ahmed, MD
- Número de teléfono: +201097920831
- Correo electrónico: M.hosnawy@med.suez.edu.eg
Ubicaciones de estudio
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Ismailia Governorate
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Ismailia, Ismailia Governorate, Egipto, 41522
- Suez Canal University hospitals
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Contacto:
- Muhammad Elhossieny Salama, MD
- Número de teléfono: 01016865861
- Correo electrónico: mohammadelhossieny88@med.suez.edu.eg
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Investigador principal:
- Muhammad Elhossieny Salama, MD
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Sub-Investigador:
- Mahmoud Hosny Ahmed, MD
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Criterios de participación
Criterio de elegibilidad
Criterio de elegibilidad
Edades elegibles para estudiar
- Adulto
- Adulto Mayor
Acepta Voluntarios Saludables
Descripción
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.
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Cuadruplicar
Número de brazos
Armas e Intervenciones
Grupo de participantes/brazoGrupo de participantes/brazo |
Intervención / TratamientoIntervención / Tratamiento |
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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.
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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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Comparador de placebos: 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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¿Qué mide el estudio?
Medidas de resultado primarias
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Total intraoperative crystalloid administration
Periodo de tiempo: 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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Medidas de resultado secundarias
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Lactate Levels
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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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Colaboradores e Investigadores
Patrocinador
Patrocinador
Publicaciones y enlaces útiles
Publicaciones Generales
- 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.
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Estimado)
Inicio del estudio
Finalización primaria (Estimado)
Finalización primaria
Finalización del estudio (Estimado)
Finalización del estudio
Fechas de registro del estudio
Enviado por primera vez
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Publicado por primera vez
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización publicada
Última actualización enviada que cumplió con los criterios de control de calidad
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Última verificación
Más información
Términos relacionados con este estudio
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
Otros números de identificación del estudio
- 6476# (Identificador de registro: Research Ethics Committee, Faculty of Medicine, Suez Canal University)
Plan de datos de participantes individuales (IPD)
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Información sobre medicamentos y dispositivos, documentos del estudio
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