The Impact of Noradrenaline on Ventriculo-arterial Coupling and Central Cardiovascular Energy Delivery
Study Details
Study Description
Brief Summary
The study aims to examine how noradrenaline in combination with venous return influences the energy transmission from heart to central circulation and arteries - also called arterio-ventricular coupling.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
After being informed about the study 40 elective CABG patients with written informed consent will undergo assessment of their arterio-ventricular coupling postoperatively after coronary bypass graft surgery. Whilst still in deep general anesthesia on the CT ICU the study population will be assessed by echocardiographic examination (transthoracic and transesophageal), blood pressure tracing by arterial line, respiratory data and ECG in 4 different situations.
Initially the individual patient is either considered fluid responsive (SVV >13%) og non- responsive (SVV<13%) by using stroke volume variation assessed by echocardiography.
In case of fluid responsiveness a fluid bolus of 4ml/kg of crystalloid fluid is given until SVV drops below 13% and the patient can be considered as fluid NON responder.
Right afterwards the study patient is stabilized with a baseline dose of noradrenaline (NA) intravenously in a supine position (situation 1). Situation 2 will be a slight increase in NA dose stabilizing mean arterial pressure in a "baseline + 20mmHg" state. After reversing the NA dose back to base line level the patient is allowed a short period of rest to wean of drug effect (4-5 x t1/2, appr. 12min). Subsequently the patient is to be placed in a 20% semi upright position (Anti-Trendelenburg) causing an increase in fluid responsiveness (situation 3). Following a phase of equilibration the dose of NA is again titrated up to obtain a 20mmHg increase in mean arterial pressure (situation 4).
There will be logging of arterial pressure curve and VTI-tracing I LVOT simultaneously (ultrapower, uPWR) as well as calculation of energy delivery, cardiac power, oscillatory power and -fraction and both arterial and ventricular elastance in every of those 4 situations.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Noradrenalin treatment with 2 different NA concentrations in 2 different states of fluid responsiveness |
Procedure: Noradrenalin
Norepinephrine challenge (concentration 'A' ) in fluid responsive position
Other Names:
Procedure: Noradrenalin
Norepinephrine challenge (concentration 'A') in non-fluid responsive position
Other Names:
Procedure: Noradrenalin
Norepinephrine challenge (concentration 'B') in fluid responsive position
Other Names:
Procedure: Noradrenalin
Norepinephrine challenge (concentration 'B') in non-fluid responsive position
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Change in Cardiac Power [within 30 minutes after having been stabilised on the cardiothoracic ICU after performed CABG surgery]
Change in Cardiac Power in reaction to both different noradrenaline doses and states of fluid responsiveness. By logging invasive BP curve and tracing left ventricular outflow tract Velocity Time Integral (by echocardiography) simultaneously Total and Mean Cardiac Power (Watt) can be determined. Examining the response to different NA doses relative to fluid responsiveness the effect of NA on arterio-ventricular coupling can be examined.
- Change in Oscillatory Power Fraction [within 30 minutes after having been stabilised on the cardiothoracic ICU after performed CABG surgery]
Change in Oscillatory Power Fraction (OPF) in reaction to both different noradrenaline doses and states of fluid responsiveness. By logging invasive BP curve and tracing left ventricular outflow tract Velocity Time Integral (by echocardiography) simultaneously Total Cardiac Power (TCP, Watt) and Cardiac Power Output (CPO, Watt) can be determined. By subtracting CPO from TCP, OPF (in %) can be calculated. Examining the response to different NA doses relative to fluid responsiveness the effect of NA on arterio-ventricular coupling can be examined.
Secondary Outcome Measures
- Change in single beat ventricular elastance [within 30 minutes after having been stabilised on the cardiothoracic ICU after performed CABG surgery]
Change in single beat ventricular elastance in reaction to both different noradrenaline doses and states of fluid responsiveness. Ventricular elastance (Ees) can be determined on the bedside by using a single beat measurement of left ventricular ejection fraction, stroke volume, preejection time and ejection time.
- Change in single beat arterial elastance [within 30 minutes after having been stabilised on the cardiothoracic ICU after performed CABG surgery]
Change in single beat arterial elastance in reaction to both different noradrenaline doses and states of fluid responsiveness. Using an estimative formula Ea can be calculated (Ea=SBPx0.9/SV) and Ea/Ees as a marker of arterio-ventricular coupling can be evaluated.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
elective coronary artery bypass graft surgery
-
requirement for Noradrenaline/Norepinephrine
Exclusion Criteria:
-
lack of informed consent
-
patient unsuitable for mean arterial pressure (MAP) elevation of 20mmHg
-
patient requiring different blood pressure range due to medical/surgical needs
-
poor image quality due to patient factors
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | St Olavs Hospital, Dep. for Anesthesia & Intensive care. Section of cardiothoracic Anesthesia and -intensive Care. | Trondheim | Norway | 7006 |
Sponsors and Collaborators
- St. Olavs Hospital
Investigators
- Study Director: Hilde Pleym (Head of Department), md, PhD, St. Olavs Hospital
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 2019/287