Study of Perioperative Evolution of Right Heart Dysfunction and Preload Responsiveness in Open Heart Cardiac Surgery

Centre Hospitalier Universitaire de Saint Etienne20 enrolled

Overview

The aim of the study was to assess the ability a Lung Recruitment Maneuver (LRM) with a stepwise increase of PEEP to predict fluid responsiveness and right cardiac dysfunction in mechanically ventilated patients in open heart cardiac surgery. During different phases, all patients received a Passive Leg Raising (PLR) maneuver for preload status evaluation using the PICCO system, a Lung Recruitment Maneuver (LRM) and an echographic evaluation of the right cardiac function. 20 patients were analyzed. Incomplete Lung Recruitment Maneuver (LRM) can predict fluid responsiveness at phase 1, pre-operatively, with a sensitivity of 0.57 and specificity of 0.62. Performance of an incomplete Magnetic Resonance Angiography (MRA) to predict right cardiac dysfunction based on TAPSE post-operatively provides a sensitivity and specificity of respectively 0.33 and 0.17 Tolerance to a stepwise lung recruitment maneuver can not be used to evaluate reliably the preload responsiveness and guide fluid therapy except pre-operatively. The use of a lung recruitment maneuver can be a promising method for right cardiac dysfunction screening but further studies need to be done with different echographic tools for right cardiac dysfunction evaluation.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Cardiac Surgery

Interventions

passive leg raising maneuver (PLR)

Passive leg raising maneuver (PLR) for preload status evaluation using the PICCO system will be realized in Phase 1 (pre operatively), Phase 2 (after the sternotomy closure in the operating room), Phase 3 (H+2 of the arrival in cardiac intensive care unit).

lung recruitment maneuver (LRM)OTHER

lung recruitment maneuver (LRM) will be realized in Phase 1 (pre operatively), Phase 2 (after the sternotomy closure in the operating room), Phase 3 (H+2 of the arrival in cardiac intensive care unit).

echographic evaluation of the right cardiac functionOTHER

echographic evaluation of the right cardiac function will be realized in Phase 1 (pre operatively), Phase 2 (after the sternotomy closure in the operating room), Phase 3 (H+2 of the arrival in cardiac intensive care unit).

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients receiving an elective or urgent cardiac surgery with or without extracorporeal circulation under general anesthesia, under protective mechanical ventilation, monitored by invasive arterial blood pressure and pulse contour analysis (PICCO system) for cardiac output measurement and central venous pressure Exclusion Criteria: * Left ventricular ejection fraction ≤ 30% * heart arrhythmia, pulmonary hypertension (SPAP \> 35 mmHg) * right heart failure (TAPSE \< 16 mm, S' at lateral tricuspid valve \< 10 cm/sec) * lower limbs obstructive arteriopathy (stage IIb, III and IV) * severe and very severe chronic obstructive pulmonary disease (COPD) * pneumothorax and extreme weights (BMI \< 35 kg/m2).

Locations (1)

CHU de Saint-Etienne

Saint-Etienne, France

Outcomes

Primary Outcomes

Fluid responsiveness measured with PiCCO system during Lung recruitment maneuver.

Measured by PICCO results (phase: 1, 2, 3).

Time frame: Months: 4

Secondary Outcomes

Analysis Right cardiac function - Transthoracic echocardiography

measured with Transthoracic echocardiography (phase 1, 3).

Time frame: Months: 4

Analysis Right cardiac function - transoesophageal echocardiography

measured with transoesophageal echocardiography (phase 1, 2).

Time frame: Months: 4

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.