Hypotension Clinical Trial
Official title:
Decision Support for Intraoperative Low Blood Pressure
Verified date | April 2019 |
Source | Vanderbilt University Medical Center |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
The purpose of this study is to determine whether a decision support system can improve the adherence to thresholds for low blood pressure by anesthesia providers, which in turn prevents their patients from having organ injury.
Status | Completed |
Enrollment | 22435 |
Est. completion date | December 29, 2018 |
Est. primary completion date | December 31, 2017 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 60 Years to 100 Years |
Eligibility |
Inclusion Criteria: - 60 years and older - Inpatients - Scheduled for a non-cardiac surgical procedure under general or central neuraxial anesthesia Exclusion Criteria: - Pre-existing end-stage renal disease: operationalized as a preoperative need for dialysis - The following surgical procedures: renal surgery, cardiac surgery, organ transplantation, ophthalmic surgery, endoscopic gastrointestinal procedures, and (interventional) radiologic procedures. - small non-invasive or minimally-invasive procedures will also be excluded, operationalized as excluding procedures with a surgical time of less than twenty minutes. |
Country | Name | City | State |
---|---|---|---|
United States | Vanderbilt University Medical Center | Nashville | Tennessee |
Lead Sponsor | Collaborator |
---|---|
Vanderbilt University Medical Center | UMC Utrecht |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Postoperative Acute Kidney Injury | Postoperative Acute Kidney Injury (AKI), Stage I or higher according to the KDIGO criteria (Kidney Disease: Improving Global Outcomes). The staging will be based on serum creatinine values, as documentation of urine output is probably not sufficiently accurate. This will be the primary outcome for the Vanderbilt University Medical Center. The creatinine measurements are part of routine clinical care. Therefore, absence of creatinine postoperative measurements are considered to be 'no suspicion of kidney injury'. KDIGO defines AKI as any of the following: Increase in serum creatinine by 0.3mg/dL or more within 48 hours or Increase in serum creatinine to 1.5 times baseline or more within the last 7 days or Urine output less than 0.5 mL/kg/h for 6 hours. Stage 1 is 1.5-9x baseline or >0.3 increase; Stage 2 is 2-2.9x baseline; Stage 3 is 3x baseline, or increase to > 4, or initiation of renal replacement therapy. | Within 7 days after surgery | |
Secondary | 30-day Mortality | Vanderbilt University Medical Center: combination of in-hospital mortality and 'alive-index' (which checks for visits to the hospital in the electronic healthcare record as indication of being alive at 30 days) | 30 days after surgery | |
Secondary | In-hospital Mortality | Hospital mortality rate during a single hospital admission after the surgery | All postoperative days during a single hospital admission, expected median of 5 days | |
Secondary | Postoperative Acute Kidney Injury Stage 2 | Postoperative Acute Kidney Injury (AKI), Stage II or higher according to the KDIGO criteria (Kidney Disease: Improving Global Outcomes). The staging will be based on serum creatinine values, as documentation of urine output is probably not sufficiently accurate. The creatinine measurements are part of routine clinical care. Therefore, absence of creatinine postoperative measurements are considered to be 'no suspicion of kidney injury'. KDIGO defines AKI as any of the following: Increase in serum creatinine by 0.3mg/dL or more within 48 hours or Increase in serum creatinine to 1.5 times baseline or more within the last 7 days or Urine output less than 0.5 mL/kg/h for 6 hours. Stage 1 is 1.5-9x baseline or >0.3 increase; Stage 2 is 2-2.9x baseline; Stage 3 is 3x baseline, or increase to > 4, or initiation of renal replacement therapy. | Within 7 days after surgery | |
Secondary | Postoperative Rise in Creatinine Levels | Absolute values for serum creatinine before and after surgery will be compared. When multiple postoperative creatinine measurements are made, the maximum difference is reported. | Within 7 days after surgery | |
Secondary | Incidence of a MAP < 60 mmHg | Incidence of a mean arterial pressure (MAP) < 60 mmHg during anesthesia for 1 minute or more. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Incidence of a MAP < 55 mmHg | Incidence of a mean arterial pressure (MAP) < 55 mmHg during anesthesia for 1 minute or more. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Incidence of a MAP < 50 mmHg | Incidence of a mean arterial pressure (MAP) < 50 mmHg during anesthesia for 1 minute or more. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Incidence of a MAP < 60 mmHg for > 10 Minutes | Incidence of a mean arterial pressure (MAP) < 60 mmHg for a cumulative duration of all hypotensive episodes of more than 10 minutes during the anesthetic phase of the procedure. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Incidence of a MAP < 55 mmHg for > 10 Minutes | Incidence of a mean arterial pressure (MAP) < 55 mmHg for a cumulative duration of all hypotensive episodes of more than 10 minutes during the anesthetic phase of the procedure. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Incidence of a MAP < 50 mmHg for > 10 Minutes | Incidence of a mean arterial pressure (MAP) < 50 mmHg for a cumulative duration of all hypotensive episodes of more than 10 minutes during the anesthetic phase of the procedure. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Incidence of a MAP < 60 mmHg for > 20 Minutes | Incidence of a mean arterial pressure (MAP) < 60 mmHg for a cumulative duration of all hypotensive episodes of more than 20 minutes during the anesthetic phase of the procedure. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Incidence of a MAP < 55 mmHg for > 20 Minutes | Incidence of a mean arterial pressure (MAP) < 55 mmHg for a cumulative duration of all hypotensive episodes of more than 20 minutes during the anesthetic phase of the procedure. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Incidence of a MAP < 50 mmHg for > 20 Minutes | Incidence of a mean arterial pressure (MAP) < 50 mmHg for a cumulative duration of all hypotensive episodes of more than 20 minutes during the anesthetic phase of the procedure. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Depth and Duration of Intraoperative Hypotension - Threshold MAP 75 mmHg | Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Depth and Duration of Intraoperative Hypotension - Threshold MAP 70 mmHg | Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Depth and Duration of Intraoperative Hypotension - Threshold MAP 65 mmHg | Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Depth and Duration of Intraoperative Hypotension - Threshold MAP 60 mmHg | Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Depth and Duration of Intraoperative Hypotension - Threshold MAP 55 mmHg | Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Depth and Duration of Intraoperative Hypotension - Threshold MAP 50 mmHg | Depth and duration of intraoperative hypotension will be modeled by calculating areas under the threshold for mean arterial pressures (MAPs). Thresholds will vary from 75 mmHg to 50 mmHg in 5 mmHg decrements. Together these variables represent the depth and duration of intraoperative hypotension. To optimize goodness of fit of these variables, the decremental steps may be increased to 10 mmHg and more restrictive lowest and highest thresholds may be chosen for the statistical analysis. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Estimated Intraoperative Blood Loss | The estimated blood loss in mL during the surgical procedure | During the surgical procedure: an expected average of 2 hours | |
Secondary | Time to Discharge Readiness at the Postanesthesia Care Unit (PACU) | The time from arriving at the postanesthesia care unit (PACU) until the time the patient is considered ready for discharge (in minutes). | A specific time frame on the day of surgery: from the start of admission to the PACU to discharge from the PACU, an expected average of 4 hours | |
Secondary | Intravenous Anesthetic Drug Use During Intraoperative Hypotension: MAP < 65 mmHg | Average concentrations of propofol infusion rates during MAP < 65 mmHg episodes | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Intravenous Anesthetic Drug Use During Intraoperative Hypotension: MAP < 60 mmHg | Average concentrations of propofol infusion rates during MAP < 60 mmHg episodes | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Intravenous Anesthetic Drug Use During Intraoperative Hypotension: MAP < 55 mmHg | Average concentrations of propofol infusion rates during MAP < 55 mmHg episodes | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Intravenous Anesthetic Drug Use During Intraoperative Hypotension: MAP < 50 mmHg | Average concentrations of propofol infusion rates during MAP < 50 mmHg episodes | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Average Use of Cardiovascular Drugs: Ephedrine | Cardiovascular drugs as defined under interventions. Average use for each drug will be calculated. Cardiovascular drugs that were given in <1% of cases are not reported, as the average dosages would be meaningless. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Average Use of Cardiovascular Drugs: Phenylephrine | Cardiovascular drugs as defined under interventions. Average use for each drug will be calculated. Cardiovascular drugs that were given in <1% of cases are not reported, as the average dosage would be meaningless. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Average Use of Cardiovascular Drugs: Glycopyrrolate | Cardiovascular drugs as defined under interventions. Average use for each drug will be calculated. Cardiovascular drugs that were given in <1% of cases are not reported, as the average dosage would be meaningless. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Average Use of Cardiovascular Drugs: Epinephrine | Cardiovascular drugs as defined under interventions. Average use for each drug will be calculated. Cardiovascular drugs that were given in <1% of cases are not reported, as the average dosage would be meaningless. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Average Use of Cardiovascular Drugs: Norepinephrine | Cardiovascular drugs as defined under interventions. Average use for each drug will be calculated. Cardiovascular drugs that were given in <1% of cases are not reported, as the average dosage would be meaningless. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Timing of Cardiovascular Drugs for MAP < 65 mmHg | Cardiovascular drugs as defined under interventions. Time of first administration of cardiovascular drug relative to the time at which the mean arterial pressure (MAP) drops below 60 mmHg. Per patient the average time to first administration of all hypotensive episodes was calculated. That average time is used as the outcome variable. A negative value indicates that administration occurred before the drop in MAP. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Timing of Cardiovascular Drugs for MAP < 60 mmHg | Cardiovascular drugs as defined under interventions. Time of first administration of cardiovascular drug relative to the time at which the mean arterial pressure (MAP) drops below 60 mmHg. Per patient the average time to first administration of all hypotensive episodes was calculated. That average time is used as the outcome variable. A negative value indicates that administration occurred before the drop in MAP. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Timing of Cardiovascular Drugs for MAP < 55 mmHg | Cardiovascular drugs as defined under interventions. Time of first administration of cardiovascular drug relative to the time at which the mean arterial pressure (MAP) drops below 55 mmHg. Per patient the average time to first administration of all hypotensive episodes was calculated. That average time is used as the outcome variable. A negative value indicates that administration occurred before the drop in MAP. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Timing of Cardiovascular Drugs for MAP < 50 mmHg | Cardiovascular drugs as defined under interventions. Time of first administration of cardiovascular drug relative to the time at which the mean arterial pressure (MAP) drops below 50 mmHg. Per patient the average time to first administration of all hypotensive episodes was calculated. That average time is used as the outcome variable. A negative value indicates that administration occurred before the drop in MAP. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Intraoperative Administration of Intravenous Fluids | Total amount (mL) of intravenous fluids (as defined under interventions) administered during the surgical procedure. | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Inhaled Anesthetic Drug Use During Intraoperative Hypotension: MAP < 65 mmHg | Average concentrations of inhalational anesthesia during MAP < 65 mmHg episodes | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Inhaled Anesthetic Drug Use During Intraoperative Hypotension: MAP < 60 mmHg | Average concentrations of inhalational anesthesia during MAP < 60 mmHg episodes | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Inhaled Anesthetic Drug Use During Intraoperative Hypotension: MAP < 55 mmHg | Average concentrations of inhalational anesthesia during MAP < 55 mmHg episodes | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours | |
Secondary | Inhaled Anesthetic Drug Use During Intraoperative Hypotension: MAP < 50 mmHg | Average concentrations of inhalational anesthesia during MAP < 50 mmHg episodes | During the anesthetic phase of the surgical procedure: an expected average of 2.5 hours |
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