Traditional Versus Goal Directed Perioperative Fluid Therapy in High Risk Patients
Traditional Versus Goal Directed Perioperative Fluid Therapy in High Risk Patients. A Randomized, Assessor-blinded Study
Is goal directed fluid therapy reducing postoperative complications in comparison to traditional fluid therapy for gastro surgical ASA III/IV patients?
The investigators compare two groups of patients: one group receives goal directed fluid therapy guided by LiDCOrapid stroke volume variation (SVV), the other gets the "traditional" fluids, ie the current regime.
研究概览
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Adult ASA class III & IV (high risk) patients
- >18 years
- scheduled for gastrointestinal surgery involving laparotomy
- Both elective and emergency cases
Exclusion Criteria:
- Atrial fibrillation
- Mental impairment, unable to give informed consent
- Severe aortic or mitral stenosis
- Type of surgery: Liver surgery, transthoracic oesophagectomy
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:单身的
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
无干预:Control
Standard monitoring.
Initial optimization of fluid status is performed by pulse, BP and anaesthesiologist assessment with Ringer acetate.
Followed by an infusion of 10ml/kg/t Ringer acetate.
Urinary output and blood pressure is used as a surrogate parameter: the infusion rate is increased by a fall in blood pressure or urine output <0.5ml/kg/t.
Bleeding replaced with HES 1:1, otherwise see table for fluid therapy page 9. Vasoactive agents (noradrenaline / phenylephrine) is given if the anesthesiologist considers this necessary.
Postoperative give 1000ml Glucose 5%.
HES or Ringer when low blood pressure, eventually noradrenaline as vasoactive agent.
|
|
实验性的:Goal directed fluid therapy
|
Standard monitoring. The patient is connected to the LiDCOrapid monitor via an arterial line placed in a.radialis. A bolus of 500 ml Ringer acetate is given before anesthesia. If the stroke volume (SV) increases more than 10%, repeat the procedure until the SV is not increasing. After that, induction of anesthesia. Maintenance fluid is given as Ringer acetate 2ml/kg/t. Continuous monitoring of stroke volume variation (SVV). If SVV> 10%, give a fluid bolus 6ml/kg Ringer acetate. Repeat until SVV <10%. Bleeding is being replaced 1:1 with hydroxyethyl starch. SAG by bleeding >1000ml. By fall in blood pressure and SVV <10%, start vasoactive treatment with epinephrine. Postoperative is given Glucose 5% 80ml/h. |
研究衡量的是什么?
主要结果指标
结果测量 |
大体时间 |
---|---|
Postoperative complications
大体时间:5 days after surgery
|
5 days after surgery
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Length of hospital stay
大体时间:3 month after surgery
|
3 month after surgery
|
|
Complications until discharge and readmission within 30 days
大体时间:3 month after surgery
|
3 month after surgery
|
|
Mortality within 30 days and 3-month after surgery
大体时间:3 month after surgery
|
3 month after surgery
|
|
Renal function
大体时间:5 days after surgery
|
defined by RIFLE criteria
|
5 days after surgery
|
Vasoactive agents need
大体时间:3 month after surgery
|
Difference in the number of patients in need of vasoactive agents, during surgery and in the postoperative period.
|
3 month after surgery
|
合作者和调查者
调查人员
- 学习椅:Ib Jammer, MD、Helse Bergen HF, Norway
出版物和有用的链接
研究记录日期
研究主要日期
学习开始
初级完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (估计)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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