Cardiac Output, High, Cardiac Output, Low
Conditions
Brief summary
Rationale: Diligent fluid management is instrumental to improve postoperative outcome, cost and quality of care. Objective: To determine the accuracy of brachial, femoral and carotid blood flow measurement with ultrasound compared to intermittent transpulmonary thermodilution cardiac output measurement, invasive and non-invasive pulse-contour analysis. Study design: Observational study - Prospective clinical non-intervention measurement study. Study population: Adult ASA 1-2 patients, scheduled for open upper GI surgery Intervention (if applicable): Not applicable. We will perform non-invasive ultrasound measurements of the femoral, carotid and brachial blood flow right before induction and under anaesthesia. Main study parameters/endpoints: Femoral, carotid and brachial blood flow determined by ultrasound and blood flow variation and the accuracy compared to transpulmonary thermodilution cardiac output, stroke volume variation, and pulse-contour analysis derived cardiac output (invasive or non-invasive) at the following time points during surgery; (limited for femoral site as it cannot be measured during surgery): (1) before induction of anaesthesia, (2) after induction, (3) 15 minutes after start of surgery, (4) before and (5) after (1-2 minutes) a fluid bolus, (6) before and (7) after start of vasopressors, (8) before and (9) after Trendelenburg position and (10) after surgery before end of anaesthesia (figure 1). A fluid bolus will be performed as part of standard care (goal-directed fluid therapy). The vasopressor and Trendelenburg position time points are optional measurements. We will also measure (continuous) invasive femoral blood pressure (SBP, DBP, MAP), non-invasive blood pressure, SVV, central venous pressure (when available), heart rate, SpO2, PFI, etCO2.
Interventions
DIAGNOSTIC_TESTcarotid blood flow measurement with ultrasound
carotid blood flow measurement with ultrasound vs transpulmonary thermodilution calibrated continuous cardiac output measurements
Sponsors
Philips Healthcare
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Elective open GI surgery * Invasive arterial blood pressure monitoring * Informed consent
Exclusion criteria
* Significant stenosis \> 30% or abnormal anatomy of aortic, femoral, carotid or brachial artery * Cerebrovascular accident * Atrial fibrillation * COPD stage 3-4 * Lobectomy / pneumectomy * Active pneumonia * Cardiac failure * Severe heart valve regurgitation or stenosis * Not able to measure brachial or carotid artery blood flow during surgery * Contra-indications for femoral arterial catheter placement (e.g., vascular graft)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cardiac output | baseline | blood flow determined by ultrasound and the accuracy compared to transpulmonary thermodilution calibrated continuous cardiac output |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cardiac output change | change from baseline cardiac output 1 minute after intervention (fluid challenge, vasopressor administration, or Trendelenburg) | Change in blood flow compared to change in cardiac output |
Countries
Netherlands
Outcome results
None listed