To investigate the influence of PEEP (Positive end-expiratory pressure), changes in preload (patient position) and changes in afterload (phenylephrine) on ultrasound measures of renal perfusion in patients after uncomplicated cardiac surgery. To investigate the effects of phenylephrine on both invasive measures of the systemic- and pulmonary circulation and, secondarily, to assess the induced changes in echocardiographic indices of left- and right ventricular systolic- and diastolic function.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
30
Three time points: before, during and 20-30 minutes after infusion of phenylephrine. Patients will receive an infusion of up to 1 mcg/kg/min phenylephrine intravenously to raise mean arterial pressure with 20 mmHg for 10 minutes. Infusion of phenylephrine will start at 0.1 mcg/kg/min with subsequent titration to effect.
Six time points based on combinations of the following: Three different levels of PEEP (as set on the ventilator): 0, 6 and 12 mmHg. Two different positions: 1) torso elevated 30 degrees, legs horizontal and 2) torso horizontal, legs elevated 30 degrees.
Aarhus University Hospital, Department of Anaesthesiology
Aarhus, Denmark
Renal arterial resistive index (RI).
Time frame: 75 minutes
The ratio SVR/PVR (systemic vascular resistance/pulmonary vascular resistance)
Time frame: 75 minutes
Renal venous impedance index.
Time frame: 75 minutes
Renal venous stasis index.
Time frame: 75 minutes
Portal vein pulsatility fraction.
Time frame: 75 minutes
Cardiac output
Time frame: 75 minutes
Arterial blood pressure, central venous pressure, pulmonary blood pressure, pulmonary capillary wedge pressure.
Time frame: 75 minutes
Transoesophageal measurement of left and right ventricular function 1
Systolic measure (ejection fraction (EF))
Time frame: 75 minutes
Transoesophageal measurement of left and right ventricular function 2
Systolic measure (s')
Time frame: 75 minutes
Transoesophageal measurement of left and right ventricular function 3
Systolic measure (strain)
Time frame: 75 minutes
Transoesophageal measurement of left and right ventricular function 4
Diastolic measures (E, A,)
Time frame: 75 minutes
Transoesophageal measurement of left and right ventricular function 5
Diastolic measures (e', a')
Time frame: 75 minutes
Transoesophageal measurement of left and right ventricular function 6
Diastolic measure (deceleration time)
Time frame: 75 minutes
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