Anesthesia, General, Coronary Artery Bypass, Coronary Artery Disease, Hypovolemia, Pulmonary Atelectasis
Conditions
Keywords
Alveolar recruitment manoeuvre, Lung recruitment, Preload dependency, Cardiac surgery, Transoesophageal echocardiography
Brief summary
The principal aim is to assess impact of alveolar recruitment manoeuvres (ARM) on stroke volume variation, evaluated by trans-oesophageal echocardiography (TEE). These variations will be measured on preload dependency or preload independency status. The principal purpose is to determine if variations of stroke volume during standardized ARM can predict the preload dependency status.
Detailed description
Population studied: anesthetized patients for cardiac surgery of coronary bypass. Secondary endpoints : - comparison between TEE and mini-invasive monitoring systems in accuracy of measurement of stroke volume variation during ARM. These mini-invasive systems are : Clearsight system (Edwards Lifescience) and Flotrac system (Edwards Lifescience) \- Difference between pre and post-cardiopulmonary bypass status on principal purpose evaluation
Interventions
OTHERtee measurement
OTHERflotrac measurement
OTHERclearsight measurement
Sponsors
University Hospital, Clermont-Ferrand
Study design
Allocation
NON_RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patient Undergoing a surgical procedure of coronary artery bypass, with cardiopulmonary bypass Written consent collected
Exclusion criteria
* Emergency case * Pericardial effusion * Aortic or mitral valvulopathy * Contraindication for : TEE, alveolar recruitment manoeuvre (emphysema, pneumothorax, hemodynamic instability), Ringer Lactate solution infusion * Bad echogenicity * Patient refusal to participate to the study * No health insurance
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Variation of stroke volume | at the beginning of cardiac surgery | Variation of stroke volume measured by TEE, induced by a standardized ARM, at the beginning of cardiac surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cardiac index (l/min/m2) | at the begining of cardiac surgery | Cardiac index (l/min/m2) (TEE measurement) |
| Right ventricle diameter/left ventricle diameter ratio | at the begining of cardiac surgery | Right ventricle diameter/left ventricle diameter ratio (TEE measurement), |
| E/A ratio | at the begining of cardiac surgery | E/A ratio (TEE measurement) |
| Sus-hepatic vein Doppler profile | at the begining of cardiac surgery | Sus-hepatic vein Doppler profile (TEE measurement) |
| Invasive arterial pressure (mmHg) | at the begining of cardiac surgery | — |
| Heart rate (pulse/min) | at the begining of cardiac surgery | — |
| Expired CO2 (mmHg) | at the begining of cardiac surgery | — |
| Central venous pressure (mmHg) | at the begining of cardiac surgery | — |
| Pulse pressure variation (%) | at the begining of cardiac surgery | — |
| Perfusion index (pulsoxymeter) | at the begining of cardiac surgery | — |
| Velocity time integral (cm) | at the begining of cardiac surgery | Velocity time integral (cm) (TEE measurement) |
| Stroke volume variation (%) (Flotrac measurement) | at the begining of cardiac surgery | — |
| Cardiac index (l/min/m2) (Flotrac measurement) | at the begining of cardiac surgery | — |
| Pulse pressure variation (%) (Flotrac measurement) | at the begining of cardiac surgery | — |
| Arterial pressure (mmHg) (Flotrac measurement) | at the begining of cardiac surgery | — |
| Stroke volume (ml) (Clearsight measurement) | at the begining of cardiac surgery | — |
| Stroke volume variation (%) (Clearsight measurement) | at the begining of cardiac surgery | — |
| Cardiac index (l/min/m2) (Clearsight measurement) | at the begining of cardiac surgery | — |
| Pulse pressure variation (%) (Clearsight measurement) | at the begining of cardiac surgery | — |
| Arterial pressure (mmHg) (Clearsight measurement) | at the begining of cardiac surgery | — |
| Near infrared spectroscopy : Cerebral SrO2 | at the begining of cardiac surgery | — |
| Stroke volume (ml) (Flotrac measurement) | at the begining of cardiac surgery | — |
Countries
France
Outcome results
None listed