In this prospective, observational study the investigators assess the perioperative course of right ventricular function in combination with the venous return in patients undergoing major non-cardiac surgery. The study aims to investigate if patients undergoing major non-cardiac surgery develop an impairment of right ventricular function and/or venous return. Furthermore, the study evaluates if an impairment of right ventricular function and/or venous return is associated to left ventricular function, arterial side of the circulation and to postoperative clinical outcome.
Study Type
OBSERVATIONAL
Department of Anesthesiology and Intensive Care Medicine, Campus Virchow Klinikum, Charité - Universitaetsmedizin
Berlin, Germany
Right ventricular function
Right ventricular function will be measured perioperatively by a combination of right ventricular stroke volume, tricuspid annular plane systolic excursion (TAPSE), hepatic venous blood flow, variations in diameter of vena cavae, and right ventricle/left ventricle-ratio.
Time frame: Up to the first postoperative day
Venous return
Venous return will be assessed perioperatively by venous return pressure gradient (dVR)
Time frame: Up to the first postoperative day
Variables of transthoracic and transesophageal echocardiography
Perioperative course of variables of transthoracic and transesophageal echocardiography
Time frame: Up to the first postoperative day
Venous return variables according to Guyton concept
Perioperative course of variables according to Guyton concept characterizing venous return
Time frame: Up to the first postoperative day
Hemodynamic variables
Hemodynamic variables are assessed by the anesthesia monitor and esophageal Doppler Monitor
Time frame: Up to the third postoperative day
Catecholamine administration
Catecholamine administration intra- und postoperative
Time frame: Up to the third postoperative day
Immunological parameter
Perioperative immunological (IL-6 und TNF-alpha)
Time frame: Up to the third postoperative day
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Endothelial parameter
Perioperative endothelial Parameter (ICAM-1)
Time frame: Up to the third postoperative day
Microvascular function
Perioperative course of variables assessing microvascular function
Time frame: Up to the first postoperative day
Blood loss
Blood loss characteristics intra- und postoperative
Time frame: Up to the third postoperative day
Fluid balance
Fluid and volume administration and balance intra- und postoperative
Time frame: Up to the third postoperative day
Organ complications
Postoperative organ complications are classified according to Clavien - Dindo classification
Time frame: Participants will be followed up until hospital discharge, an average of two weeks
Postoperative pain
Postoperative pain will be measured by Numeric Rating Scale - Visualized (NRS-V), the Faces Pain Scale - Revised (FPS-R), the Behavioral Pain Scale (BPS) or the Behavioral Pain Scale for Non-Intubated (BPS-NI)
Time frame: Up to the third postoperative day
Hospital length of stay
Time frame: Participants will be followed up until hospital discharge, an average of two weeks
Intensive care unit length of stay
Time frame: Participants will be followed up until intensive crae unit discharge, an average of two days
Quality of life
Assessed with EQ-5D questionnaire
Time frame: Baseline and hospital discharge with an expected average of 14 days
Functional status
Measured by the Barthel activities of daily living (ADL) index and activities of daily living (IADL).
Time frame: Baseline and hospital discharge with an expected average stay of 14 days