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HPI monitoring and the adoption of therapeutic interventions before hypotension occurs should be ensure a shorter time of intra-operative hypotension (MAP < 65 mmHg) during deceased-donor kidney transplant surgery. The control group is represented by patients undergoing the same surgical procedure with hemodynamic monitoring with invasive blood pressure monitoring which represents the gold standard for this surgery. HPI monitoring has not yet been investigated during this surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| HPI group | Experimental | Conventional therapy and monitoring with ACUMEN sensor (Edwards Lifesciences, Irvine, USA) and Hemosphere platform (Edwards Lifesciences, Irvine, USA) of invasive blood pressure. Strategy to prevent hypotension based on HPI index, Eadyn and dP/dTmax. |
|
| Control group | Active Comparator | Conventional therapy according to standard monitoring in the operating room which includes invasive blood pressure monitoring. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ACUMEN (Edwards Lifesciences, Irvine, USA) | Device | ACUMEN sensor generates HPI index which should predict hypotension. Based on HPI index, Eadyn and dP/dTmax values anaesthesia should somministrate liquid or drugs to prevent hypotension. |
| Measure | Description | Time Frame |
|---|---|---|
| Intra-operative hypotension time | Hypotension (MAP < 65 mmHg) time relative to the range from 20 minutes after induction to the end of surgery | From 20 minutes after anaesthesia induction to the end of surgery (intra-operative) |
| Measure | Description | Time Frame |
|---|---|---|
| Post-operative hypotension time | Hypotension (MAP < 65 mmHg) time relative to the range from the end of surgery to the first 12 hours after surgery | From the end of surgery to the first 12 hours after surgery (post-operative) |
| Intra-operative severe hypotension time |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Antonio Siniscalchi, MD | Contact | +390512143131 | antonio.siniscalchi@aosp.bo.it | |
| Lorenzo Querci, MD | Contact | +393933980223 | lorenzo.querci@studio.unibo.it |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| IRCCS Azienda Ospedaliero-Universitaria di Bologna | Recruiting | Bologna | 40100 | Italy |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25500761 | Background | Biancofiore G, Cecconi M, Rocca GD. A web-based Italian survey of current trends, habits and beliefs in hemodynamic monitoring and management. J Clin Monit Comput. 2015 Oct;29(5):635-42. doi: 10.1007/s10877-014-9646-7. Epub 2014 Dec 12. | |
| 27466988 | Background | Perilli V, Aceto P, Sacco T, Modesti C, Ciocchetti P, Vitale F, Russo A, Fasano G, Dottorelli A, Sollazzi L. Anaesthesiological strategies to improve outcome in liver transplantation recipients. Eur Rev Med Pharmacol Sci. 2016 Jul;20(15):3172-7. |
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| Invasive Blood Pressure | Device | Invasive Blood Pressure permits continue monitoring of blood pressure (routine standard for kidney transplant surgery) |
|
Severe hypotension (MAP < 50 mmHg) time relative to the range from 20 minutes after induction to the end of surgery |
| From 20 minutes after anaesthesia induction to the end of surgery (intra-operative) |
| Major Adverse Cardiovascular Events (MACE) | Number of major cardiovascular complications (MACE) within the first five days after kidney transplantation (for MACE the composite endpoint of heart attack is considered heart failure, heart failure or presumed cardiac death) | First 5 post-operative days after surgery (post-operative) |
| Hospital mortality | Number of patient died in the first 30 days after surgery | First 30 post-operative days after surgery (post-operative) |
| Intensive Care Unit Length of Stay | Number of hours of ICU admission | First 30 post-operative days after surgery (post-operative) |
| Hospital Length of Stay | Number of days before hospital discharge | First 30 post-operative days after surgery (post-operative) |
| Delayed Graft Function (DGF) | Need for hemodialysis in first 7 postoperative days | First 7 post-operative days (post-operative) |
| Graft survival | 30 days after transplantation |
| Post-operative delirium | CAM-ICU positive (asses one time for a day in the first 5 postoperative days) | First 5 post-operative days |
| 21884645 | Background | Vincent JL, Rhodes A, Perel A, Martin GS, Della Rocca G, Vallet B, Pinsky MR, Hofer CK, Teboul JL, de Boode WP, Scolletta S, Vieillard-Baron A, De Backer D, Walley KR, Maggiorini M, Singer M. Clinical review: Update on hemodynamic monitoring--a consensus of 16. Crit Care. 2011 Aug 18;15(4):229. doi: 10.1186/cc10291. |
| 20530615 | Background | Lobo SM, Rezende E, Knibel MF, Silva NB, Paramo JA, Nacul FE, Mendes CL, Assuncao M, Costa RC, Grion CC, Pinto SF, Mello PM, Maia MO, Duarte PA, Gutierrez F, Silva JM Jr, Lopes MR, Cordeiro JA, Mellot C. Early determinants of death due to multiple organ failure after noncardiac surgery in high-risk patients. Anesth Analg. 2011 Apr;112(4):877-83. doi: 10.1213/ANE.0b013e3181e2bf8e. Epub 2010 Jun 8. |
| 16749940 | Background | Pearse RM, Harrison DA, James P, Watson D, Hinds C, Rhodes A, Grounds RM, Bennett ED. Identification and characterisation of the high-risk surgical population in the United Kingdom. Crit Care. 2006;10(3):R81. doi: 10.1186/cc4928. Epub 2006 Jun 2. |
| 18489613 | Background | Jhanji S, Thomas B, Ely A, Watson D, Hinds CJ, Pearse RM. Mortality and utilisation of critical care resources amongst high-risk surgical patients in a large NHS trust. Anaesthesia. 2008 Jul;63(7):695-700. doi: 10.1111/j.1365-2044.2008.05560.x. Epub 2008 May 16. |
| 27004412 | Background | Fischer MO, Fiant AL, Boutros M, Flais F, Filipov T, Debroczi S, Pasqualini L, Rhanem T, Gerard JL, Guittet L, Hanouz JL, Alves A, Parienti JJ; PANEX3 study group. Perioperative hemodynamic optimization using the photoplethysmography in colorectal surgery (the PANEX3 trial): study protocol for a randomized controlled trial. Trials. 2016 Mar 22;17:159. doi: 10.1186/s13063-016-1278-4. |
| 20966436 | Background | Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. 2011 Jun;112(6):1392-402. doi: 10.1213/ANE.0b013e3181eeaae5. Epub 2010 Oct 21. |
| 25759947 | Background | Gomez-Izquierdo JC, Feldman LS, Carli F, Baldini G. Meta-analysis of the effect of goal-directed therapy on bowel function after abdominal surgery. Br J Surg. 2015 May;102(6):577-89. doi: 10.1002/bjs.9747. Epub 2015 Mar 11. |
| 18031528 | Background | Walsh SR, Tang T, Bass S, Gaunt ME. Doppler-guided intra-operative fluid management during major abdominal surgery: systematic review and meta-analysis. Int J Clin Pract. 2008 Mar;62(3):466-70. doi: 10.1111/j.1742-1241.2007.01516.x. Epub 2007 Nov 21. |