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In this prospective observational study investigators aim to seek for any possible correlation between the venous to arterial carbon dioxide difference (pCO2 gap) at the end of surgery and the percentage of time spent above a predefined threshold of stroke volume (SV) andn mean arterial pressure (MAP).
During major urological surgery (i.e. cistectomy) investigators will use a minimally invasive hemodynamic monitoring system (Flotrac - Vigileo, Edwards ) to guide fluid therapy and vasopressors administration. More specifically stroke volume target will be defined as the maximum SV after a series of fluid boluses, with a 10% tolerance. MAP was considered adequate if above 65 mmHg. After the induction of anesthesia, then each hour during surgery until the end of surgical procedure investigators will assess the time of adherence to the hemodynamic protocol (in terms of both SV and MAP) and the correspondent pCO2 gap. Investigators expect to find an inverse proportionality between the two parameters explored.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| FloTrac patients | patients belong to this group will be managed with a stroke volume target hemodynamic protocol |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ev1000 Clinical Platform from Edwards Lifesciences | Device | The EV1000 Hemodynamic monitoring platform will be used to guide fluid administration following a volume-based parameter such the stroke volume. |
| Measure | Description | Time Frame |
|---|---|---|
| Correlation between the time-in target of MAP and the pCO2 gap at the end of surgery | The primary outcome will explore the hypothesis that patient with higher adherence of MAP levels above 65 mmHg will have a lower pCO2 gap at the end of surgery | an average of 8 hours |
| Correlation between the time-in target of SV and the pCO2 gap at the end of surgery | The co-primary outcome will explore the hypothesis that patient with higher adherence of SV within the maximum value with a 10% tolerance, will have a lower pCO2 gap at the end of surgery | an average of 8 hours |
| Measure | Description | Time Frame |
|---|---|---|
| incidence of postoperative overall complications | investigators will assess the impact of the intraoperative hemodynamic optimization on the rate of postoperative complications | up to 30 days |
| duration of hospitalization |
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Inclusion Criteria:
Exclusion Criteria:
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Patients scheduled for major urological surgery who met the above mentioned inclusion criteria will be enrolled. All patients will belong the only study group in which a target-based hemodynamic protocol will be applied
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| Name | Affiliation | Role |
|---|---|---|
| Andrea Russo, MD | Department of Anesthesiology | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Andrea Russo | Rome | 00166 | Italy |
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investigators will prospectively evaluate the association between an intraoperative goal-directed fluid therapy with the long of stay
| an average of 2 weeks |