Is it possible to reconstruct intraoperative left ventricular end-systolic pressure-volume relations from a combination of non-invasive finger arterial blood pressure measurements and transoesophageal echocardiography in patients undergoing surgery…
ID
Source
Brief title
Condition
- Other condition
Synonym
Health condition
Intraoperatieve cardiale dysfunctie
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
1. Validation of the construction of pressure volume loops and end systolic
pressure volume relation using transoesophageal echocardiography and continuous
non-invasive blood pressure monitoring with the Nexfin
2. Relation between dicrotic notch pressure and beat average pressure
3. Validation of phenylephrine-induced vasoconstriction to use as a loading
intervention to construct the end systolic pressure volume relation from a set
of pressure-volume loops.
Secondary outcome
Not applicable
Background summary
Methods currently used to monitor cardiac function are invasive and have a risk
of complications causing morbidity and mortality. Also, none of the currently
used techniques provide direct information on cardiac contractile function.
Here we will investigate a method with transoesophageal echocardiography and
non-invasive finger arterial blood pressure waveforms to non-invasively
construct pressure-volume loops to describe the end-systolic pressure-volume
relations in the heart. This may provide a method to obtain more insight on
cardiac contractile function and the interaction of the heart with the
vasculature during surgery. This novel method may extend currently available
non-invasive intraoperative monitoring standards and contribute to
intraoperative therapeutic decision-making. The results of this project may
further provide basis for future applications, such as real-time intraoperative
PV-loop reconstruction.
Study objective
Is it possible to reconstruct intraoperative left ventricular end-systolic
pressure-volume relations from a combination of non-invasive finger arterial
blood pressure measurements and transoesophageal echocardiography in patients
undergoing surgery?
Study design
Prospective observational clinical trial
Study burden and risks
The study starts and ends in the operating room. Finger blood pressure
measurements using Nexfin will not add up to patient discomfort.
Transoesophageal echocardiography is standard in cardiac surgery, and is
increasingly used in non-cardiac surgery. Echocardiography is performed while
patients are under anesthesia, and the burden and risks associated with this
procedure are minimal. For the construction of the pressure-volume loops,
patients will undergo two loading interventions: vena cava compression and
administration of phenylephrine. Vena cava compression decreases preload and
blood pressure and may be associated with short-term arrhythmias and decreased
coronary perfusion. Phenylephrine is routinely used during anesthesia as
vasconstrictor, and is in some cases associated with reflex bradycardia.
De Boelelaan 1117
1081 HV Amsterdam
NL
De Boelelaan 1117
1081 HV Amsterdam
NL
Listed location countries
Age
Inclusion criteria
Patients scheduled for elective:
A. Open abdominal surgery, laparotomy
B. Open cardiac surgery, Coronary Artery Bypass Graft (CABG);A+B:
- Age18-75 years
- informed consent
Exclusion criteria
Group A (open abdominal surgery) specific:
- Known / documented cardiac disease
- ECG / echocardiography abnormalities;Group A+B:
Contraindications for transesophageal echocardiography
Contraindications for arterial line
Contraindications for administration of phenylephrine
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL35259.029.10 |