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SurgeryPhase 4NCT02312999

Crystalloids or Colloids for Goal-directed Fluid Therapy With Closed-loop Assistance in Major Surgery

A Phase 4 study testing Plasmalyte and Volulyte in people with Surgery, run by Brugmann University Hospital at 2 sites in Belgium.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Study goal: This study will examine whether there is a significant difference in postoperative outcomes between GDFT using a colloid solution versus a crystalloid solution. Hypothesis: Perioperative fluid optimization through the use of a closed-loop assistance with a balanced starch solution (volulyte®) will be… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Surgery
What is being tested?
Plasmalyte and Volulyte
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
160 participants
Where
2 sitesBelgium
Study dates
24 Feb 2015to 21 Dec 2017
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adult patients (over the age of 18) undergoing elective major abdominal surgery that is expected to take longer than 3 hours and requiring a general anesthesia and a minimally invasive cardiac output monitoring (Vigileo/Flotrac)
  • Patients who provide written informed consent

Who cannot join

  • Patients under 18 years of age
  • Patients not undergoing surgery, requiring anesthesia, or cardiac output monitoring
  • Patients with arrhythmia and/or atrial fibrillation
  • Patients who are allergic to HES
  • Patients with renal insufficiency (serum creatinine of >2 mg/ml) or hepatic dysfunction (liver enzymes >1.5)
  • Patients who has coagulation disorders (please define: values higher than 1.5x normal values
Show all 9Show fewer
  • Patients without the capacity to give written informed consent or refusal of consent
  • Patients included in another protocol within a period of 3 months or Participating in another randomised trial
  • Pregnancy at time of enrolment.

Trial locations and contacts

2 sites in 1 country.

Belgium2 sites
  • CHU Brugmann

    Brussels, 1020

  • Erasme

    Brussels, 1070

Other trials in Belgium

About this study

Official title: Phase IV, Multicentric, Prospective, Controlled, Randomized, Double Blind Study Comparing a Crystalloid to a Colloid Used in the Perioperatory Hemodynamic Optimisation With a 'Closed Loop' Automatic Filling System, on the Post-surgery Morbidity in Major Abdominal Surgery.

Study goal: This study will examine whether there is a significant difference in postoperative outcomes between GDFT using a colloid solution versus a crystalloid solution.

Hypothesis: Perioperative fluid optimization through the use of a closed-loop assistance with a balanced starch solution (volulyte®) will be associated with a decrease in postoperative complications compared to the same approach using a balanced crystalloid solution (Plasmalyte®).

Objective: To establish which kind of intravenous fluid used for goal directed therapy with closed-loop assistance will reduce the number of postoperative complications (evaluation made by the POMS score).

Read the detailed description

Controversy still persists regarding the type of fluid to use in the operating room to avoid hypovolemia and any circulatory insufficiency. While crystalloids and colloid solutions are frequently used to optimize intravascular volume during surgery, crystalloid solutions require more volume for hemodynamic optimization which may result in higher volumes of fluid administration and potentially side effects. Compared with crystalloids, colloids have the advantages of remaining in the intravascular space longer, achieving faster circulatory stabilization, maintaining colloid osmotic pressure and increasing micro perfusion. However, colloids are more expensive and may have various side effects.

In addition to the effect of crystalloids and colloids on the patient, the amount of each fluid administered is also under debate. Goal-directed fluid therapy (GDFT) strategies based on cardiac output (CO) optimization have been shown to benefit moderate- to high-risk surgery patients and have recently been recommended by professional societies in the UK, in France, and in Europe. However, despite the growing evidence, these strategies are often not implemented in current practice. One of the reasons for this lack of implementation is that GDFT strategies, like any other complex clinical protocol, require significant provider attention and vigilance for consistent implementation and it is well known that even under study conditions protocol compliance rates are often not greater than 50% In another hand, one of the chief complicating factors in fluid administration studies is variation in provider administration practices, even when attempting to follow a protocol. Previous studies have used closed-loop (automated) systems to deliver fluid by a standardized protocol, removing variation between providers as one of the confounders of the study. Dr. Cannesson and Rinehart (UC Irvine, California, USA) have recently developed and used a closed-loop system for the provision of GDFT in clinical studies at UC Irvine and La Pitie hospital in France. The closed-loop system is beneficial because it involves the standardization of fluid management and all patients are treated equivalently. This system will thus provide consistent GDFT for all cases in the protocol and remove inter-provider variability as a confounder between groups.

Study goal: This study will examine whether there is a significant difference in postoperative outcomes between GDFT using a colloid solution versus a crystalloid solution.

Hypothesis: Perioperative fluid optimization through the use of a closed-loop assistance with a balanced starch solution (volulyte®) will be associated with a decrease in postoperative complications compared to the same approach using a balanced crystalloid solution (Plasmalyte®).

Objective: To establish which kind of intravenous fluid used for goal directed therapy with closed-loop assistance will reduce the number of postoperative complications (evaluation made by the POMS score).

Conditions
Surgery
Being tested
Plasmalyte, Volulyte
Keywords
laparotomy, plasma-Lyte, volulyte, close loop, abdominal surgery

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • PlasmalyteDrug

  • VolulyteDrug

Study groups in NCT02312999
Study groupRoleWhat they receive
VolulyteExperimentalA baseline crystalloid infusion (plasmalyte®) will be set by the attending physician at 3 cc/kg/hr (standard patient care) for each of the randomized groups. The patient will receive fluid management via a closed loop (automated) system that will use an infusion pump (Q-Core) and a controller (a computer run index and algorithm developed by Sironis) to standardize the way fluids are administered intra-operatively and eliminate variation between clinical providers. The liquid perfused will be bolus amounts of volulyte.
Receives: Drug: Volulyte
Plasma-LyteActive comparatorA baseline crystalloid infusion (plasmalyte®) will be set by the attending physician at 3 cc/kg/hr (standard patient care) for each of the randomized groups. The patient will receive fluid management via a closed loop (automated) system that will use an infusion pump (Q-Core) and a controller (a computer run index and algorithm developed by Sironis) to standardize the way fluids are administered intra-operatively and eliminate variation between clinical providers. The liquid perfused will be bolus amounts of plasma-lyte.
Receives: Drug: Plasmalyte

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. POMS score

    Difference between the 2 groups in postoperative morbidity identified with the Post-Operative Morbidity Survey (POMS score) on postoperative days 2.

    Measured: 48 hours

Secondary outcomes (17)
  1. Mortality rate

    Difference in 30-day post-operative mortality between the 2 groups

    Measured: 30 days

  2. Length of hospitalisation

    Difference in duration of hospital length of stay as well as ICU length of stay.

    Measured: every day up to 90 days after hospitalisation

  3. Quantity of fluid administered during surgery

    Fluid balance during surgery

    Measured: 24 hours

  4. Transfusion rate

    Differences of transfusion rate between the two groups, in ml

    Measured: 8 days

  5. Hypotension incidence

    Incidence of hypotension (defined as total case time spent with 20% drop from baseline preoperative blood pressure).

    Measured: 8 days

  6. Need of vasopressors

    Difference in the need and quantity of vasopressors between the two groups

    Measured: 24 hours

  7. Mean case cardiac index (L /BSA)

    Mean case cardiac index (L /BSA), Mean case cardiac stroke volume index (mL/ BSA).

    Measured: 24 hours

  8. Whodas scale

    Enrolled patients will be contacted by phone and their quality of life assessed by the Whodas scale

    Measured: 6 months after surgery

  9. Whodas scale

    Enrolled patients will be contacted by phone and their quality of life assessed by the Whodas scale

    Measured: 1 year after surgery

  10. Pruritus apparition

    Enrolled patients will be contacted by phone 6 months after surgery and any pruritus apparition will be recorded

    Measured: 6 months after surgery

  11. Pruritus apparition

    Enrolled patients will be contacted by phone 1 year after surgery and any pruritus apparition will be recorded

    Measured: 1 year after surgery

  12. Renal function - urea level

    Urea levels. Measured in a blood sample taken according to the standard of care outpatient post-operative follow appointments.

    Measured: 6 months after surgery

  13. Renal function - urea level

    Urea levels. Measured in a blood sample taken according to the standard of care outpatient post-operative follow appointments.

    Measured: 1 year after surgery

  14. Renal function - creatinine level

    Creatinine levels. Measured in a blood sample taken according to the standard of care outpatient post-operative follow appointments.

    Measured: 6 months after surgery

  15. Renal function - creatinine level

    Creatinine levels. Measured in a blood sample taken according to the standard of care outpatient post-operative follow appointments.

    Measured: 1 year after surgery

  16. Renal function - Estimated glomerular filtration rate (eGFR)

    Creatinine levels. Measured in a blood sample taken according to the standard of care outpatient post-operative follow appointments.

    Measured: 6 months after surgery

  17. Renal function - Estimated glomerular filtration rate (eGFR)

    Creatinine levels. Measured in a blood sample taken according to the standard of care outpatient post-operative follow appointments.

    Measured: 1 year after surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Dec 2014 (estimated)
  2. Study start24 Feb 2015
  3. Primary completion21 Dec 2017
  4. Study completion21 Dec 2017

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
160 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02312999
Sponsor's protocol ID
CHUB-fluides
Status last verified
Jan 2018
First submitted
5 Dec 2014
Last updated
19 Jan 2018
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Feldheiser A, Pavlova V, Bonomo T, Jones A, Fotopoulou C, Sehouli J, Wernecke KD, Spies C. Balanced crystalloid compared with balanced colloid solution using a goal-directed haemodynamic algorithm. Br J Anaesth. 2013 Feb;110(2):231-40. doi: 10.1093/bja/aes377. Epub 2012 Oct 30.

    PubMed 23112214
  • Silva JM Jr, de Oliveira AM, Nogueira FA, Vianna PM, Pereira Filho MC, Dias LF, Maia VP, Neucamp Cde S, Amendola CP, Carmona MJ, Malbouisson LM. The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study. Crit Care. 2013 Dec 10;17(6):R288. doi: 10.1186/cc13151.

    PubMed 24326085
  • Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Aneman A, Madsen KR, Moller MH, Elkjaer JM, Poulsen LM, Bendtsen A, Winding R, Steensen M, Berezowicz P, Soe-Jensen P, Bestle M, Strand K, Wiis J, White JO, Thornberg KJ, Quist L, Nielsen J, Andersen LH, Holst LB, Thormar K, Kjaeldgaard AL, Fabritius ML, Mondrup F, Pott FC, Moller TP, Winkel P, Wetterslev J; 6S Trial Group; Scandinavian Critical Care Trials Group. Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. N Engl J Med. 2012 Jul 12;367(2):124-34. doi: 10.1056/NEJMoa1204242. Epub 2012 Jun 27.

    PubMed 22738085
  • Cannesson M. Arterial pressure variation and goal-directed fluid therapy. J Cardiothorac Vasc Anesth. 2010 Jun;24(3):487-97. doi: 10.1053/j.jvca.2009.10.008. No abstract available.

    PubMed 20022261
  • Ramsingh DS, Sanghvi C, Gamboa J, Cannesson M, Applegate RL 2nd. Outcome impact of goal directed fluid therapy during high risk abdominal surgery in low to moderate risk patients: a randomized controlled trial. J Clin Monit Comput. 2013 Jun;27(3):249-57. doi: 10.1007/s10877-012-9422-5. Epub 2012 Dec 22.

    PubMed 23264068
  • Pearse RM, Harrison DA, MacDonald N, Gillies MA, Blunt M, Ackland G, Grocott MP, Ahern A, Griggs K, Scott R, Hinds C, Rowan K; OPTIMISE Study Group. Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery: a randomized clinical trial and systematic review. JAMA. 2014 Jun 4;311(21):2181-90. doi: 10.1001/jama.2014.5305.

    PubMed 24842135

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Plasmalyte and Volulyte in people with Surgery, run by Brugmann University Hospital at 2 sites in Belgium.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 19 Jan 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Belgium. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

POMS score (time frame: 48 hours). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02312999, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Jan 2018.

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