Imaging Microcirculation and Gross Hemodynamics in Elective Colorectal Surgery (IMAGES)
Imaging Microcirculation And Gross Hemodynamic Assessment of the Bowel During Elective Colorectal Surgery
Rationale: The interaction between macro and microcirculation remains uncertain. Microvascular alterations can occur when systemic hemodynamic parameters are within an acceptable range. Perfusion changes and microvascular alterations may play an important role in anastomotic healing and the onset of anastomotic leakage after gastrointestinal surgery. Nowadays, assessment of bowel perfusion is macroscopically performed by the surgeon prior to anastomosis creation. However, local oxygen delivery may still be compromised as little is known about microcirculatory alterations of the bowel during colorectal surgery. Dark Field (DF) imaging is a technique using a stroboscopic light-emitting diode ring-based imaging modality incorporated in a hand-held device, which illuminates an area of interest and provides high contrast dynamic images of the microvasculature. DF-imaging enables to visualize the bowel's microcirculation.
Objective: To describe the human gastrointestinal microcirculation during gastrointestinal surgery under general anesthesia and to observe whether there is a correlation between bowel microcirculation and systemic hemodynamic parameters.
Study design: A prospective, single center, observational, clinical, pilot study.
Study population: 70 patients undergoing elective, gastrointestinal surgery during which the gastrointestinal tract is accessible for DF-imaging.
Main study parameters/endpoints: To describe human gastrointestinal microcirculation on both the serosal and mucosal side of the bowel during gastrointestinal surgery under general anesthesia. Main parameter: Microvascular perfusion is quantified using the Microvascular Flow Index (MFI).
Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The extend of burden and risk associated with participation is negligible. Using DF imaging on the bowel is a non-invasive technique requiring a minimal amount of time as is described in the study procedure. Previous studies did not show any safety concerns. Measuring will be performed under sterile conditions and the occurrence of tissue damage is highly unlikely. Patients are under general anesthesia and will thus not experience any inconvenience.
Descripción general del estudio
Tipo de estudio
Inscripción (Anticipado)
Contactos y Ubicaciones
Ubicaciones de estudio
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Nieuwegein, Países Bajos
- St Antonius hospital
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Método de muestreo
Población de estudio
70 patients undergoing elective, gastrointestinal surgery. Surgical procedures included will be:
- All forms of open colorectal surgery;
- Pylorus Persevering PancreaticoDuodenectomy (PPPD);
- Other procedures requiring small bowel resection for cancer;
- Laparoscopic procedures with extracorporeal creation of the bowel anastomosis. These procedures provide unique access to different parts of the bowel. The PPPD procedure provides access to the mucosal and serosal side of the jejunum. Colorectal surgery provides access to both the serosal and mucosal side of the colon and the terminal ileum is sometimes also accessible. We expect to include around 2 patients per week.
Descripción
Inclusion Criteria:
- All patients aged >18 scheduled for elective, gastrointestinal surgery (as described above) with signed informed consent.
Exclusion Criteria:
• Age <18 years;
- Atrial fibrillation (because of possible interference with FloTrac™/Vigileo™ cardiac output monitor);
- Left ventricular ejection fraction ≤30%;
- Serious pulmonary disease (resting pO2 <90% at room air);
- Renal failure (clearance <30 ml/min as calculated using the Modification of Diet in Renal Disease formula);
- Liver failure;
- No signed informed consent.
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Microvascular flow index (MFI)
Periodo de tiempo: Intra-operative
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During surgery
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Intra-operative
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Medidas de resultado secundarias
Medida de resultado |
Periodo de tiempo |
|---|---|
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Perfused vessel density (PVD)
Periodo de tiempo: Intra-operative
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Intra-operative
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Proportion of perfused vessels (PPV)
Periodo de tiempo: Intra-operative
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Intra-operative
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Total vessel density (TVD)
Periodo de tiempo: Intra-operative
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Intra-operative
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Heterogeneity index (HI)
Periodo de tiempo: During surgery
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During surgery
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Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Mat Van Iterson, PhD, St. Antonius Hospital
Publicaciones y enlaces útiles
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio
Finalización primaria (Actual)
Finalización del estudio (Actual)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Estimar)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Otros números de identificación del estudio
- NL4833210014
Plan de datos de participantes individuales (IPD)
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