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Electric Cardiometry-Guided Standard Versus Restricted Fluid Therapy In Robotic Prostaectomy
Effect Of Standard Versus Restricted Fluid Therapy Guided By Electric Cardiometry On Tissue Perfuison In Robotic Prostaectomy: A Randomized Controlled Study
Fluid therapy during surgery is an important factor that is related to long term mortality and morbidity and it's directly related to tissue perfusion as well. The main target in any surgery is what is the optimum fluid therapy to maintain the tissue perfusion and the precise balance between hazardous effects of hypervolemia that may cause delayed wound healing due to surgical anastomosis disruption or being hypovolemic that may cause tissue ischemia as acute kidney injury.
Fluid management guidance changed from static methods like central venous pressure into dynamic methods like pulse pressure variation (PPV) and stroke volume variation (SVV), which are now the most famous dynamic measures.
Electrical cardiometry is a non-invasive cardiac output monitor which uses electrical cardiometry, now a commonly used device, to measure SVV which can be used to guide fluid therapy during surgeries.
Now robotic assisted surgery is a common method in preforming many surgeries especially urological, since it's associated with numerous desirable outcomes including shorter post-operative stay and faster return to preoperative function.
With considerations related to severe Trendelenburg position and increased intra-abdominal pressure due to pneumo-peritoneum, robotic assisted surgeries are associated with many challenges in anesthesia especially the fluid therapy.
Fluid therapy in robotic surgeries is an area with growing research focus that need further exploration while there are established guidelines for fluid management in traditional surgeries, the optimal protocols for robotic surgeries are less well defined, needing more research.
We aim at this study to investigate the impact of liberal versus restricted fluid intake on the tissue perfusion reflected by serum lactate & creatinine clearance, while guiding therapy through electrical cardiometry, to reach optimum fluid protocol in prostatic robotic surgeries.
Studie Overzicht
Toestand
Interventie / Behandeling
Studietype
Inschrijving (Geschat)
Fase
- Niet toepasbaar
Contacten en locaties
Studiecontact
- Naam: Mohamed M Mohamed, M.Sc.
- Telefoonnummer: +20 111 8370641
- E-mail: mandamembo0@gmail.com
Studie Contact Back-up
- Naam: Nazmy S Mikhael, M.D.
- Telefoonnummer: +20122 7400808
- E-mail: drnazmyseif@kasralainy.edu.eg
Studie Locaties
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Cairo, Egypte
- Werving
- Cairo university hospitals
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Contact:
- Mohamed M Mohamed, M.Sc.
- Telefoonnummer: +20 111 8370641
- E-mail: mandamembo0@gmail.com
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Contact:
- Nazmy S Mikhael, M.D.
- Telefoonnummer: +201227400808
- E-mail: drnazmyseif@kasralainy.edu.eg
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
- Volwassen
- Oudere volwassene
Accepteert gezonde vrijwilligers
Beschrijving
Inclusion Criteria:
- Male patient undergoing robotic assisted prostatectomy
- ASA I-III
Exclusion Criteria:
- ASA score more than III
- BMI more than 40
- Severe renal disease (GFR between 15 and 29)
- Previous renal surgery.
- Decompensated cardiac disease (NYHA class 3 or 4)
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Ondersteunende zorg
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Dubbele
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
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Actieve vergelijker: Liberal Group
Liberal Fluid Therapy Group
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Patients will receive 6 ml/kg/hour of lactated ringer for maintenance in addition to fasting hours compensation (2 ml/kg for each fasting hour, given as 50% in the first hour of surgery, then 25% during the second & third hours).
An additional bolus of 200 ml Lactated Ringer will be given if MAP is below 65 mmHg.
In case of persistent hypotension despite proper fluid rescuistation, 10 mg of Ephedrine will be administered; if no response is achieved, norepinerhine infusion will start at initial dose 0.01mcg/kg/min if MAP is below 65 mmHg.
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Actieve vergelijker: Restricted Group
Restricted Fluid Therapy Group
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Patients will receive 2 ml/kg as fluid bolus then 2 ml/kg/hour for maintenance, aiming at a target SVV less than 13 %.
Patients with SVV ≥ 13% will be considered fluid responder and will receive a fluid bolus of 200 ml Ringer Lactated Ringer over 10 minutes.The fluid bolus will be repeated until the SVV is less than 13%.
In case of persistent hypotension (MAP less than 65mmHg), 10 mg of Ephedrine will be administered; if no response is achieved, norepinerhine infusion will be started at intial dose 0.01mcg/kg/min if MAP is below 65 mmHg.
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Serum Lactate level difference
Tijdsspanne: 24 hours
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Serum Lactate level difference between pre-operative (baseline) value and post-operative (recovery) value in mmol/L
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24 hours
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Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Studie stoel: Ashgan R Aly, M.D., Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University
- Hoofdonderzoeker: Nazmy S Mikhael, M.D., Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University
- Studie directeur: Mohamed M Mohamed, M.Sc., Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University
Studie record data
Bestudeer belangrijke data
Studie start (Werkelijk)
Primaire voltooiing (Geschat)
Studie voltooiing (Geschat)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Werkelijk)
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
- Urogenitale ziekten
- Genitale ziekten
- Genitale neoplasmata, mannelijk
- Urogenitale neoplasmata
- Neoplasmata per site
- Neoplasmata
- Genitale ziekten, man
- Prostaat Ziekten
- Mannelijke urogenitale ziekten
- Metabole ziekten
- Pathologische aandoeningen, tekenen en symptomen
- Voedings- en stofwisselingsziekten
- Tekenen en symptomen
- Prostaatneoplasmata
- Oedeem
- Hyperlactatemie
Andere studie-ID-nummers
- ECGSVRFTRP
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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