Obesity Clinical Trial
Official title:
Intraoperative Goal-directed Fluid Management in Lean and Obese Patients
The investigators propose to determine esophageal Doppler goal-directed fluid requirements in lean, overweight, obese, and morbidly obese patients with the goal of developing a body mass index (BMI)-specific fluid replacement strategy. Specifically, th investigators will test the hypothesis that perioperative fluid requirements on a per-kg basis varies as a function of BMI. Individuals scheduled for elective, open abdominal surgeries, vaginal hysterectomies or genital prolapse repair will be eligible to participate
Recent evidence suggests that goal-directed fluid management using stroke volume (blood
ejected by the heart) is the most physiologic approach for fluid replacement. We propose to
develop a body mass index (BMI)-specific fluid replacement formula based on stroke volume
guidance.
Arterial pulse pressure variation (dPP) induced by mechanical ventilation is a proposed
predictor of fluid responsiveness as well. We will therefore also investigate if stroke
volume (measured by esophageal Doppler monitoring) and pulse pressure variation comparably
predict fluid responsiveness by simultaneously measuring both parameters.
Adequate tissue oxygenation is essential to maintain normal physiologic functions. Fat
tissue oxygenation is critically low in the obese surgical patient. It is likely that poor
fat tissue oxygenation results in part from inadequate fluid replacement. We propose to
determine if fat tissue oxygenation is comparable from lean to morbidly obese patients when
fluid replacement is optimized.
Individuals scheduled for elective, open abdominal surgeries, vaginal hysterectomies or
genital prolapse repair will be assigned to six groups according to BMI, from lean to
morbidly obese categories. The primary aim will be to develop a statistical equation for
predicting fluid requirements as a function of BMI. A maximum of 100 patients will be able
to detect an R-squared of 10% or more with 90% power at the 0.05 significance level, and
will enable adequate estimation of the relationship of interest.
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