post-cardiac surgery, capillary leak, patients post heart surgery, fluid leakage
Conditions
Interventions
No therapeutic intervention will take place.A pacemaker wire is routinely placed by the cardiac surgeon after the surgery, as part of the standard care that occurs with every surgery.As part of the st
Sponsors
Maastricht Universitair Medisch Centrum +
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: Aged 18 years or older.Underwent CABG surgery, without concomitant valve surgery.Admitted to the ICU during the first postoperative day.Equipped with surgically placed temporary atrial pacemaker wire.Scheduled for a 500 mL bolus of balanced solution (Ringer’s lactate) within the first two postoperative hours for clinical reasons.Able to provide preoperative consent at the outpatient clinic before the surgery takes place.Assessed by the attending intensivist as hemodynamically stable and (thereby) eligible for the study.
Exclusion criteria
Exclusion criteria: Presence of atrial fibrillation or other arrhythmias precluding atrial pacing.Absence of atrial pacemaker wire.Suspected cardiac tamponade or significant postoperative bleeding (e.g., >400 mL blood loss in the first hour postoperatively).Use of extracorporeal life support (ECLS) during the observation period.Acute changes in vasopressor or inotrope dosage within the observation period.Significant changes in body position, ventilator settings, or pacing mode during the study protocol.Known contraindications to echocardiographic monitoring or arterial wave form analysis.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Main study parameter/endpointThe main study parameter is the change in stroke volume measured before and after fluid administration in response to beat-to-beat atrial pacing. Stroke volume will be assessed using VTI of the LVOT via transthoracic echocardiography. This change will be compared between fluid responders (defined as a =10% increase in stroke volume following fluid administration) and non-responders to assess the predictive accuracy of the pacing protocol. | — |
Secondary
| Measure | Time frame |
|---|---|
| The secondary study parameters include:Arterial wave form analysis (via intra-arterial blood pressure monitoring) to compare the ability of wave form analysis to detect stroke volume changes.Complementation of the clinical findings with computer simulations (CircAdapt) in a comparable virtual cohort of patientsCVP measurements during the pacing protocol to evaluate changes in preload.Clinical outcomes, including the incidence of any adverse events related to the pacing protocol (e.g., arrhythmias, hypotension, or complications during fluid administration). | — |
Countries
Netherlands
Contacts
Public ContactRGH Driessen
Maastricht Universitair Medisch Centrum +
Outcome results
None listed