Optimising blood-circulation and oxygen delivery in planned abdominal aortic surgery

ISRCTN ISRCTN24645910
DOI https://doi.org/10.1186/ISRCTN24645910
Secondary identifying numbers N/A
Submission date
03/08/2010
Registration date
03/09/2010
Last edited
13/09/2017
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Surgery
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Not provided at time of registration

Contact information

Prof Palle Toft
Scientific

Department of Anaesthesiology and Intensive Care
Odense University Hospital
Sdr. Boulevard 29
Odense
5000
Denmark

Email palle.toft@ouh.regionsyddanmark.dk

Study information

Study designProspective randomised partly blinded controlled trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typePrevention
Participant information sheet Not available in web format, please use contact details below to request a patient information sheet
Scientific titleOptimising stroke volume and oxygen delivery in elective abdominal aortic surgery: a randomised controlled trial
Study objectivesElective abdominal aortic surgery is performed in patients with aneurism or occlusive atherosclerotic disease. These patients often have severe co-morbidity and are at high risk of postoperative complications. Maintaining optimal circulation during aortic surgery is difficult due to aortic cross clamping and often profound haemorrhage in combination with anaesthetising a patient with general atherosclerotic disease.

Precise and individual circulatory therapy can be performed by continuously monitoring and optimising the patient's stroke volume and oxygen delivery during and after surgery. Optimisation is performed by giving colloid boluses to achieve the individual optimal stroke volume intraoperatively, supplemented by infusion of Dobutamine postoperatively to maintain delivery of oxygen above 600 ml min-1 m-2 .

This protocol may reduce postoperative complications and death, as well as length of stay in the Intensive Care Unit and hospital.
Ethics approval(s)The Local Medical Ethics Committee (Den Videnskabsetiske Komite for Region Syddanmark) approved in June 2008 (ref: S-20080055)
Health condition(s) or problem(s) studiedElective abdominal aortic surgery; Atherosclerotic abdominal aortic occlusive disease; Abdominal aortic aneurism
InterventionPatients were assigned to Individual Goal Directed Therapy (IGDT) or control groups by computer-generated random sequence.

The intervention period started preoperatively, when monitoring with the Lithium Dilution Cardiac Output (LiDCO)-plus-system was established and calibrated at arrival to the operating theatre. The intervention period ended 6 hours postoperatively. Patients were followed for 30 days postoperatively.

Establishment and calibration of the LiDCO-plus-system were carried out by a member of the research team who had no involvement in the peri- and postoperative care and decision making. This allowed complete blinding of both surgical, anaesthetic and Post Anaesthetic Care Unit (PACU) clinical teams to LiDCO-plus-system readings in the control group.

All anaesthetic interventions were at the discretion of the anaesthetist responsible for the perioperative management of the patient. All patients received general anaesthesia with fentanyl, thiopental, rocuronium and sevoflurane in oxygen/air. Before induction of anaesthesia an epidural catheter was inserted at the low thoracic level and an epidural infusion of bupivacain with fentanyl was started and continued until postoperative day 2 or 3.

Standard monitoring for both groups included continuous pulse oxymetri, electrocardiography, invasive arterial and central venous blood pressure monitoring, and spirometry with inspiratory and expiratory oxygen, carbondioxide and anaesthetic gas monitoring. Arterial blood gases were analysed at predefined points in both groups.

Stroke volume index (SVI), cardiac index (CI) and oxygen delivery index (DO2I) were continuously monitored, by lithium indicator dilution and pulse power analysis using the LiDCO-plus-system in all patients, but data was blinded in the control group.

All patients were treated to achieve a heart rate < 100 bpm or <20% above baseline, a mean arterial pressure (MAP) between 60-100 mgHg, a central venous pressure (CVP) between 4-16, body temperature > 36,5°C, an arterial oxygen saturation (SaO2) > 94%, a haemoglobin concentration > 6 mmol l-1, and an urine output > 0.5-1.0 ml min-1 kg-1 in the postoperative period.

In all patients crystalloid, colloid, blood products and vasopressors were administered in the peri-and postoperative periods by the anaesthetist based on intra- and postoperative losses, standard haemodynamic parameters and blood-gases.

Intervention: Patients in the IGDT group in the peri- and postoperative period received 250 ml boluses of intravenous colloid solution (Voluven®, Fresenius Kabi AB, Upsala, Sweden ) to achieve a sustained rise in SVI of at least 10% for 20 min. Fluid boluses of Voluven® were repeated if SV subsequently decreased or if there was clinical suspicion of hypovolaemia. Furthermore, in the postoperative period, the IGDT group received dobutamine up to a maximum of 10 ug kg-1 min-1 if DO2I did not reach 600 ml min-1 m-2 with intravenous fluid alone. During infusion of dobutamine, monitoring was supplemented with 5-lead-electrocardiography, and at signs of myocardiel ischemia or heart rate > 100 min-1 or > 20% above baseline, infusion was reduced or discontinued.
Intervention typeProcedure/Surgery
Primary outcome measureOne or more severe postoperative complications:
1. Septic shock
2. Pneumonia
3. Superficial wound infection
4. Deep wound infection
5. Abdominal infection
6. Urinary tract infection
7. Pulmonary embolus
8. Acute Respiratory Distress Syndrome (ARDS)
9. Cardiac arrest
10. Acute coronary syndrome
11. Cardiac arrhythmia (acute treatment needed)
12. Pulmonary oedema
13. Deep venous thrombosis
14. Cerebral thrombosis
15. Cerebral haemorrhage
16. Lower limb paresis
17. Acute kidney insufficiency
18. Intraabdominal hypertension
19. Severe upper gastrointestinal bleeding
20. Gastrointestinal paralysis
21. Creatine Kinase (CK) > 5000
22. Reoperation
23. Readmission to ICU
24. Need of respirator
25. Need of hemodialysis
26. Dead
Secondary outcome measures1. Flow-related haemodynamic parameters (SVI and Do2I) measured by the LiDCO-plus-system (LiDCO Ltd., Cambridge, UK)
2. Length of stay in Intensive Care Unit
3. Length of hospital stay
Overall study start date01/06/2008
Completion date01/01/2010

Eligibility

Participant type(s)Patient
Age groupAdult
SexBoth
Target number of participants85
Key inclusion criteriaConsecutive patients admitted for elective abdominal aortic surgery
Key exclusion criteria1. Chronic renal end-failure
2. Preoperative Lithium therapy
3. Body weight < 40 Kg (88,18 lbs)
Date of first enrolment01/06/2008
Date of final enrolment01/01/2010

Locations

Countries of recruitment

  • Denmark

Study participating centre

Department of Anaesthesiology and Intensive Care
Odense
5000
Denmark

Sponsor information

Department of Anaesthesiology Kolding (Denmark)
Hospital/treatment centre

Lillebaelt Hospital Kolding
Skovvangen 2-8
Kolding
6000
Denmark

Phone +45 7636 2000
Email jannie.bisgaard@slb.regionsyddanmark.dk
ROR logo "ROR" https://ror.org/037y5zq83

Funders

Funder type

Hospital/treatment centre

Lillebaelt Hospital Kolding (Denmark) - Local research fund

No information available

The Toyota Fund (Denmark)

No information available

Research Initiative of The Danish Society of Anaesthesiology and Intensive Care Medicine (Denmark)

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Other publications 01/01/2010 Yes No
Results article 01/02/2013 Yes No

Editorial Notes

HF 13/09/2017: corrected pub stage.