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Transesophageal echocardiography (TEE) as guide for tailoring perioperative fluid therapy to achieve individualized hemodynamic endpoint, target hemodynamic goals of stroke volume index (SVI) greater than 35 mL/m2 and cardiac index greater than 2.5 L/min/m2 and tissue oxygen delivery.
Lactate levels as a surrogate indicator of organ perfusion as measured by arterial blood gas analysis intraoperatively, after 12 hours and 48 hrs postoperatively
TEE as guide for tailoring perioperative fluid therapy to achieve target hemodynamic goals of stroke volume index (SVI) greater than 35 mL/m2 and cardiac index greater than 2.5 L/min/m2 and tissue oxygen delivery.
GDT (goal directed therapy): continuous infusion of crystalloids 2 mL/kg/h.
If (velocity time integral) VTI <20, 250 mL colloid bolus administered. Dose repeated every 10 min until goal of VTI >20 met. Norepinephrine titrated to maintain MAP(mean arterial pressure) > 65 mm Hg. Blood transfused for haemoglobin <8 g Lactate levels as a surrogate indicator of organ perfusion as measured by arterial blood gas analysis at time of incision intraoperatively and after 12 hours and 48 hrs. The incidence of postoperative complications, morbidity, mortality, duration of mechanical ventilation and ICU stay.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group A (stroke volume variation) guided fluid | Active Comparator | Stroke volume variation guided intraoperative intravenous fluid will be administered. |
|
| Group B(Study group) TEE guided fluid | Active Comparator | Transesophageal echocardiography will be used to guide the fluid therapy. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TEE guided fluid therapy will be administered | Other | Transesophageal echocardiography will be used to guide the fluid therapy. Velocity time integral of aorta <20 ,200ml colloid bolus to be administered. |
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative complications | The incidence of postoperative complications in percentage | 48 hours |
| Measure | Description | Time Frame |
|---|---|---|
| intraoperative fluid | Amount of intraoperative fluid in litres to be compared | intraoperative period (hours) |
| median icu stay | duration of icu stay |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Rajiv Gandhi Cancer Institute | Delhi | 110085 | India |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 11376533 | Result | Guarracino F. [The role of transesophageal echocardiography in intraoperative hemodynamic monitoring]. Minerva Anestesiol. 2001 Apr;67(4):320-4. Italian. | |
| 24354071 | Result | Trinooson CD, Gold ME. Impact of goal-directed perioperative fluid management in high-risk surgical procedures: a literature review. AANA J. 2013 Oct;81(5):357-68. |
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TEE as guide for tailoring perioperative fluid therapy to achieve individualized hemodynamic endpoint , target hemodynamic goals of stroke volume index (SVI) greater than 35 mL/m2 and cardiac index greater than 2.5 L/min/m2 and tissue oxygen delivery. Lactate levels as a surrogate indicator of organ perfusion as measured by arterial blood gas analysis intraoperatively , after 12 hours and 48 hrs postoperatively.
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The intensivist taking care of the patient postoperatively not aware of the intervention
| Stroke volume variation guided intravenous fluid. | Other | Active Comparator: Group A control group (SVV guided fluid ) Stroke volume variation guided intraoperative intravenous fluid will be administered. SVV >10, 200 ml of colloid bolus to be given |
|
| 1 week |