Goal-directed fluid therapy is one of the most accepted strategies in intraoperative fluid therapy, although potential fluid overload is a possible drawback. Fluid overload has recently been shown to cause damage to the glycocalyx and to increase extravasation of fluids into the interstitial space. This study aims to determine whether liberal fluid administration during moderate surgery results in impairment to the endothelial glycocalyx and causes edema. Participants will be randomized to receive either a liberal or restrictive fluid protocol with vasopressor support. The investigators will measure interstitial edema by clinical signs, pulmonary congestion by ultrasound, and extracellular water by bioimpedance. Impairment of glycocalyx will be estimated by measuring blood levels of shedding markers. In addition, wound healing and early postoperative outcome will be estimated by POMS.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
SINGLE
Enrollment
51
During the surgical procedure and the subsequent stay in the Post-Anesthesia Care Unit: if the study participant's urine output (UO) remains \<0.3 ml/kg/h for two consecutive hours, an IV bolus of 250 ml of lactated Ringer's solution will be administered over 15 min and repeated every 30 min until the UO reaches \>0.3 ml/kg/h.
During their stay in the Post-Anesthesia Care Unit, patients will receive a 1.5 ml/kg/h IV infusion of lactated Ringer's solution.
Hadassah Ein-Carem Medical Center
Jerusalem, Israel
Change from preoperative serum concentration of Heparan Sulfate.
Measured using blood samples drawn from a peripheral vein of the study participant and analyzed in a laboratory.
Time frame: Two hours after completion of surgery.
Change from preoperative serum concentration of Syndecan-1.
Measured using blood samples drawn from a peripheral vein of the study participant and analyzed in a laboratory.
Time frame: Two hours after completion of surgery.
Change from preoperative serum concentration of Hyaluronic Acid.
Measured using blood samples drawn from a peripheral vein of the study participant and analyzed in a laboratory.
Time frame: Two hours after completion of surgery.
Change from preoperative serum concentration of Sphingosine-1-Phosphate.
Measured using blood samples drawn from a peripheral vein of the study participant and analyzed in a laboratory.
Time frame: Two hours after completion of surgery.
Appearance of B-lines on lung ultrasonography.
Bilateral ultrasonography of the study participant's lungs, performed by a physician using two views: posterior and lateral.
Time frame: Two hours after completion of surgery.
Early appearance of peripheral pitting edema.
Bilateral physical examination of the study participant's wrists and ankles, performed by a physician.
Time frame: Two hours after completion of surgery.
Late appearance of peripheral pitting edema.
Bilateral physical examination of the study participant's wrists and ankles, performed by a physician.
Time frame: During the first postoperative day.
Postoperative Morbidity Survey (POMS) Score.
Clinically evaluated by a physician for each study participant.
Time frame: During the first postoperative day.
Early change in the percentage of Total Body Water and Extracellular Water.
Measured by bioimpedance using a commercially available device connected to the study participant.
Time frame: Immediately after completion of surgery.
Late change in the percentage of Total Body Water and Extracellular Water.
Measured by bioimpedance using a commercially available device connected to the study participant.
Time frame: Two hours after completion of surgery.
Change from preoperative body weight.
Recorded while the study participant stands on an electronic scale.
Time frame: During the first postoperative day.
Volume of urine produced during the procedure.
Measured using a volumetric graduated urine collection container connected to a Foley catheter placed in the urinary bladder of the study participant.
Time frame: Immediately after completion of surgery.
Change from preoperative Heart Rate.
Measured using a continuous electrocardiography monitor connected to the study participant.
Time frame: Immediately after completion of surgery.
Change from preoperative Mean Arterial Blood Pressure.
Measured using an automated oscillometric blood pressure monitoring device with its cuff placed on one of the arms of the study participant.
Time frame: Immediately after completion of surgery.
Early change from preoperative Cardiac Output.
Measured non-invasively using a commercially available device connected to the study participant.
Time frame: Immediately after completion of surgery.
Late change from preoperative Cardiac Output.
Measured non-invasively using a commercially available device connected to the study participant.
Time frame: Two hours after completion of surgery.
Early change from preoperative serum concentration of C-Reactive Protein.
Measured using blood samples drawn from a peripheral vein of the study participant and analyzed in a laboratory.
Time frame: Immediately after completion of surgery.
Late change from preoperative serum concentration of C-Reactive Protein.
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Measured using blood samples drawn from a peripheral vein of the study participant and analyzed in a laboratory.
Time frame: Two hours after completion of surgery.
Early change from preoperative serum concentration of Lactate.
Measured using blood samples drawn from a peripheral vein of the study participant and analyzed in a laboratory.
Time frame: Immediately after completion of surgery.
Late change from preoperative serum concentration of Lactate.
Measured using blood samples drawn from a peripheral vein of the study participant and analyzed in a laboratory.
Time frame: Two hours after completion of surgery.
Change from preoperative serum concentration of Creatinine.
Measured using blood samples drawn from a peripheral vein of the study participant and analyzed in a laboratory.
Time frame: Immediately after completion of surgery.
Change from preoperative serum concentration of Hemoglobin.
Measured using blood samples drawn from a peripheral vein of the study participant and analyzed in a laboratory.
Time frame: Immediately after completion of surgery.