Assessment of Fluid Responsiveness in Patients After Cardiac Surgery

Overview

To overcome the limited accuracy of functional hemodynamic parameters such as stroke volume and pulse pressure variation (SVV and PPV) during spontaneous breathing, a Passive Leg Raising (PLR) manoeuvre has been suggested as a reliable predictor of fluid responsiveness. Aim of this study was to evaluate fluid responsiveness using SVV, PPV and PLR during the transition from controlled to spontaneous breathing in cardiac surgery patients

Full Title of Study: “Assessment of Fluid Responsiveness in Patients After Cardiac Surgery Comparison of Different Functional Hemodynamic Parameters and Tests”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: November 2015

Detailed Description

In patients after elective off-pump CABG are enrolled hemodynamic measurements are performed in the postoperative period upon arrival in the ICU using a PiCCO2 system (Pulsion Medical Systems, Munich, Germany). Controlled fluid challenges (500 ml) are done at 3 time-points: A) during controlled mechanical ventilation B) during pressure support ventilation with spontaneous breathing and C) after extubation. Stroke volume (SV), SVV and PPV as well as standard hemodynamic parameters (MAP = mean arterial pressure, HR = heart rate) are assessed. A PLR is performed before fluid administration at all 3 time points. A positive response is defined as an increase in SV>15 %. Prediction of fluid responsiveness will be tested by AUC (area under the receiver operating characteristic – ROC – curve).

Interventions

  • Other: Passive leg raising test and fluid challenge

Clinical Trial Outcome Measures

Primary Measures

  • Stroke volume increase > 15%
    • Time Frame: 20 min
    • Stroke volume increase defines fluid responsiveness

Participating in This Clinical Trial

Inclusion Criteria

  • preserved left ventricular function – regular heart rhythm Exclusion Criteria:

  • emergency procedures – intra- and extra-cardial shunts – aortic and tricuspid valve insufficiencies – peripheral arterial occlusive disease

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 80 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Triemli Hospital
  • Provider of Information About this Clinical Study
    • Principal Investigator: Christoph K Hofer, MD DEAA – Triemli Hospital
  • Overall Official(s)
    • Christoph K Hofer, MD DEAA, Principal Investigator, Triemli City Hospital

References

Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009 Sep;37(9):2642-7. doi: 10.1097/CCM.0b013e3181a590da.

Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, Teboul JL. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med. 2006 May;34(5):1402-7. doi: 10.1097/01.CCM.0000215453.11735.06.

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