Atrial Natriuretic Peptide in Assessing Fluid Status

Petrovsky National Research Centre of Surgery30 enrolled

Overview

Biomarkers can play a significant role in fluid status assessment intraoperatively.

Routinely intraoperatively the fluid status assessment is based on central venous pressure and other parameters. Nevertheless, the minority of anesthesiologists use continous dynamic parameters like pulse pressure variation, stroke volume variation and other to manage fluid status. There's a fast acting biomarker that can help anesthesiologist to diagnose and manage the volemic status and possibly guide the infusion therapy better. Pro-ANP is a biomarker that reacts on atria strain and can be used in volemic status assessment in cardiac surgery patients.

Study Type

INTERVENTIONAL

Allocation

Purpose

DIAGNOSTIC

Masking

NONE

Enrollment

Conditions

Fluid Overload Fluid Loss Volume Overload Cardiac Disease Cardiac Output, Low Cardiac Output, High

Interventions

pro-ANPDIAGNOSTIC_TEST

pro-ANP samples and fluid status assessment with functional tests (Teboul test) will be used 8 times intraoperatively.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: CABG, one-, two valve repair/replacement, ascending aorta, aortic arch replacement, ASD/AVD closure, septal myectomy Exclusion Criteria: 1. Atrial fibrillation, atrial flutter, frequent ventricular and supraventricular arrythmias 2. EFLV \< 50% 3. Pulmonary hypertension \> 2 st 4. CKD \> C3 (GFR \< 30) 5. Redo surgery 6. Left atrium volume \> 150 ml 7. LV EDV \> 250 ml

Locations (1)

Petrovsky Research National Centre of Surgery (Petrovsky NRCS)

Moscow, Russia

Outcomes

Primary Outcomes

Number of Patients With Pro-ANP Twofold Raise by the End of Surgery

To assess the atria strain and consequent rise of pro-ANP by the end of surgery

Time frame: intraoperatively

Number of Patients With Pro-ANP Increase > 10% by the PLR Maneuver

According to positive PLR the assessment of pro-ANP consequent raise

Time frame: intraoperative

Number of Patients With Cardiac Index Rise > 10% After Passive Leg Raising Maneuver

Using Massimo vigileo hard- and software the first assessment of cardiac index was made before Teboul test after the trachea intubation. After 10 minutes of passive leg raising maneuver second assessment. If raise in cardiac index above 10 percent was detected the patient was considered a responder. If not - non-responder.

Time frame: 10 minutes of PLR test

Number of Patients With Pro-ANP Increase > 10% by the PLR Maneuver at the End of Surgery

Using Massimo vigileo hard- and software the assessment of cardiac index was made before Teboul test at the end of surgery before leaving the operating room. After 10 minutes of passive leg raising maneuver second assessment. If raise in cardiac index above 10 percent was detected the patient was considered a responder. If not - non-responder.

Time frame: 10 minutes of PLR test

Secondary Outcomes

Postoperative Complications

Total amount of various postoperative complications

Time frame: up to 10 days

Mortality

Mortality rate

Time frame: up to 10 days

Multiorgan Failure

Data from ClinicalTrials.gov

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