In Elderly Patients, Does Goal-directed Fluid Management Using the Carotid Corrected Flow Time (CC-FT) Index, Compared to Routine Fluid Management, Affect the Occurrence of Post-induction Hypotension?
Effect of Carotid Corrected Flow Time-Guided Volume Management on Post-Induction Hypotension in Elderly Patients
This study aims to find out whether using a simple ultrasound measurement of blood flow in the neck artery can help doctors decide how much fluid to give older patients before general anesthesia, and thereby reduce the drop in blood pressure that commonly occurs after anesthesia induction. Older adults are more likely to experience low blood pressure during anesthesia, and such drops have been linked to kidney injury, heart injury, and even death after surgery. Giving too little fluid can worsen organ blood supply, while giving too much can cause fluid overload, lung swelling, and heart strain. Currently, doctors often rely on static measures such as central venous pressure, or on invasive dynamic measures such as pulse pressure variation, but these have limited accuracy or require expensive equipment and invasive procedures. Carotid corrected flow time (FTc), measured non-invasively with ultrasound, reflects left ventricular preload and has shown promise for predicting fluid responsiveness, including in spontaneously breathing patients. However, evidence in older adults undergoing abdominal surgery remains limited to observational studies, and higher-level evidence from randomized trials is needed. We therefore plan a single-center, prospective, randomized, parallel-controlled trial in 70 patients aged 65 years or older scheduled for elective abdominal surgery under general anesthesia. Participants will be randomly assigned 1:1 to an FTc-guided prehydration group or a conventional fluid group. In the intervention group, if FTc falls below 340.7 ms, 250 mL of lactated Ringer's solution will be infused over 15 minutes, and FTc will be re-measured until it reaches at least 340.7 ms, in addition to a background infusion of 6 mL/kg/h started 30 minutes before induction. The control group will receive the same background infusion without FTc-guided adjustment. The primary outcome is the incidence of post-induction hypotension, defined as mean arterial pressure below 65 mmHg or a decrease of more than 20% from baseline within 15 minutes after induction. Secondary outcomes include the area under the curve of mean arterial pressure change from baseline during induction, intraoperative use of vasoactive agents, actual pre-induction fluid volume, postoperative pulmonary complications (pulmonary edema), acute kidney injury, myocardial injury, adverse events in the post-anesthesia care unit, time to first flatus and defecation, and all-cause mortality within 30 days after surgery.
Primary Hypothesis
Compared with conventional fluid management, carotid FTc-guided prehydration before anesthesia induction will reduce the incidence of post-induction hypotension in older patients undergoing elective abdominal surgery under general anesthesia.
Studie Overzicht
Toestand
Toestand
Conditie
Conditie
Interventie / Behandeling
Interventie / Behandeling
Studietype
Studietype
Inschrijving (Geschat)
Inschrijving
Fase
Fase
- Niet toepasbaar
Contacten en locaties
Studiecontact
Studiecontact
- Naam: Zhihong LU Zhihong LU
- Telefoonnummer: 86029-84775343
- E-mail: deerlu23@163.com
Deelname Criteria
Geschiktheidscriteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
Age ≥ 65 years;
Scheduled for elective abdominal surgery under general anesthesia.
Exclusion Criteria:
ASA physical status > III;
BMI > 30 kg/m² or < 18.5 kg/m²;
History of neck surgery or neck trauma;
History of peripheral arterial disease or arteriosclerosis, carotid artery stenosis exceeding one-third of the lumen, or significant anatomical variation of the carotid artery;
NYHA functional class > III;
History of cardiomyopathy or valvular heart disease;
Non-sinus rhythm;
Concomitant hypotension due to conditions such as septic shock;
Refusal to participate in the study.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Preventie
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Verdrievoudigen
Aantal wapens
Wapens en interventies
Deelnemersgroep / ArmDeelnemersgroep / Arm |
Interventie / BehandelingInterventie / Behandeling |
|---|---|
|
Experimenteel: CC-FT Guided Fluid Management Group
atients will receive fluid management guided by the Carotid Corrected Flow Time (CC-FT) index during anesthesia induction. |
Patients will receive fluid management guided by the Carotid Corrected Flow Time (CC-FT) index during anesthesia induction. |
|
Actieve vergelijker: Conventional Fluid Management Group
Patients will receive routine fluid management based on standard clinical parameters during anesthesia induction. |
Patients will receive routine fluid management based on standard clinical parameters during anesthesia induction. |
Wat meet het onderzoek?
Primaire uitkomstmaten
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
ncidence of post-induction hypotension
Tijdsspanne: defined as within 15 minutes after induction
|
Incidence of MAP < 65 mmHg or a decrease of more than 20% from baseline |
defined as within 15 minutes after induction
|
Medewerkers en onderzoekers
Sponsor
Sponsor
Studie record data
Bestudeer belangrijke data
Studie start (Geschat)
Studie start
Primaire voltooiing (Geschat)
Primaire voltooiing
Studie voltooiing (Geschat)
Studie voltooiing
Studieregistratiedata
Eerst ingediend
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Werkelijk)
Eerst geplaatst
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update geplaatst
Laatste update ingediend die voldeed aan QC-criteria
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
Andere studie-ID-nummers
- XJH-A-20261015
Plan Individuele Deelnemersgegevens (IPD)
Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?
Informatie over medicijnen en apparaten, studiedocumenten
Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel
Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct
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