Bypass ComplicationsNCT02328846
Transcutaneous-Arterial Carbon Dioxide and Microcirculatory Dysfunction
An observational study of Bypass Complications, run by University of Virginia.
Trial summary
Evaluation of the microcirculation is currently limited. Continual assessment of the tissue carbon dioxide-arterial carbon dioxide (PtC02-aCO2) offers a new, novel and noninvasive method of determining the state of the microcirculation. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Bypass Complications
- How many people
- 0 participants
- Where
- No sites listed yet
- Study dates
- Jan 2018to Feb 2020
- Phase
- Observational
- 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
Study population: Subjects undergoing cardiac surgery with cardiopulmonary bypass
Who may be able to join
- Age > 18 years
- Elective cardiac surgery
- Must be able to read and speak English
Who cannot join
- Subjects unable/unwilling to give informed consent
- Emergency surgery
- Age < 18 years
- Pregnant females-self reported
- Prisoners
About this study
Official title: Transcutaneous-Arterial Carbon Dioxide Gradient Predicts Microcirculatory Dysfunction And The Development of Organ Failure After Cardiac Surgery
Evaluation of the microcirculation is currently limited. Continual assessment of the tissue carbon dioxide-arterial carbon dioxide (PtC02-aCO2) offers a new, novel and noninvasive method of determining the state of the microcirculation. The investigators will apply two non-invasive devices, the Braedius sidesteam darkfield microscopy (SDF) microscopy device to the sublingual circulation and the transcutaneous PtC02 probe to the forehead in subjects undergoing cardiac surgery with cardiopulmonary bypass. The PtC02-aCO2 gradient will be determined and correlated with the videomicroscopic images of the sublingual microcirculation. Thereafter the incidence of postoperative organ failure and acute kidney injury will be determined and correlated with PtC02-arterial CO2 gradient and videomicroscopic images.
Data will be analyzed by standard descriptive statistical methods.
Read the detailed description
There is increasing evidence that despite resuscitation and normalization of macrohemodynamic parameters (blood pressure and cardiac output) significant dysfunction of the microcirculation may persist.1, 2 There is also a positive correlation between the severity of microcirculatory dysfunction and outcome in patients with septic shock. In contrast, early improvements in microcirculatory perfusion in response to macrohemodynamic goal directed therapy is associated with an improvement in organ function.3 Monitoring the microcirculation is challenging. The monitoring window (e.g. the sublingual bed) must be reflective of other remote vascular beds. This is more likely to be the case in the setting of systemic diseases such as sepsis and hypovolemic shock. Current research modalities for studying the microcirculation include laser Doppler and videomicroscopy.4 The limitation of these devices is that assessment of the microcirculation has to be performed off-line and targets for microvascular resuscitation have not been established. Therefore, microvascular monitoring is currently restricted to the research arena. Evaluation of the tissue transcutaneous carbon dioxide (PtC02) is a novel, non-invasive, real-time method of assessing the microcirculation.5, 6 The three major determinants of PtC02 are arterial carbon dioxide (PaCO2), oxygen consumption (VCO2) and the tissue blood flow. Under normal conditions, an increased tissue metabolism (thus VCO2) is coupled with an increased tissue perfusion, largely reducing any PtC02 increase ("washout" phenomenon). Therefore, if PaCO2 is constant, an increase in PtC02 reflects an inadequate relationship between metabolism and tissue perfusion. PtC02 thus represents a good estimate of tissue perfusion. To overcome the influence of PaCO2 on PtC02, it is convenient to use the carbon dioxide gap (tissue-arterial carbon dioxide gradient, normal<7 mmHg). Very high gap values may in addition suggest the presence of tissue hypoxia while moderately elevated gaps may represent either flow stagnation or tissue hypoxia. Cardiac surgery is characterized by significant alteration of the microvascular circulation. These changes are observed in both on-pump and off-pump cases and with pulsatile and non-pulsatile flow. Monitoring the PtC02-arterial CO2 gradient offers a rapid real-time measure of the microvascular abnormalities encountered during the post-cardiopulmonary bypass (CPB) period and their effect on post-CPB organ dysfunction.
- Conditions
- Bypass Complications
What is being measured
The primary outcome is the main question the study is designed to answer.
Postoperative SOFA score
Measured: Participants will be followed for the duration of ICU stay, an expected average of 1 weeks
Secondary outcomes (1)
Postoperative Kidney Disease Improving Global Outcome (KDIGO) class
Measured: Participants will be followed for the duration of ICU stay, an expected average of 1 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted31 Dec 2014 (estimated)
- Study startJan 2018 (estimated)
- Primary completionJan 2019 (estimated)
- Study completionFeb 2020 (estimated)
Why it stopped: Insufficient equipment
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Bypass ComplicationsStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 0 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Virginia
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Bhiken I. Naik, MD, University of Virginia
- Investigators
- Bhiken I Naik, M.B.B.Ch, Principal investigator, University of Virginia
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02328846
- Sponsor's protocol ID
- 17872
- Status last verified
- Oct 2018
- First submitted
- 18 Dec 2014
- Last updated
- 22 Oct 2018
- Results posted
- No
- Data monitoring committee
- No
Publications
Asfar P, Meziani F, Hamel JF, Grelon F, Megarbane B, Anguel N, Mira JP, Dequin PF, Gergaud S, Weiss N, Legay F, Le Tulzo Y, Conrad M, Robert R, Gonzalez F, Guitton C, Tamion F, Tonnelier JM, Guezennec P, Van Der Linden T, Vieillard-Baron A, Mariotte E, Pradel G, Lesieur O, Ricard JD, Herve F, du Cheyron D, Guerin C, Mercat A, Teboul JL, Radermacher P; SEPSISPAM Investigators. High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2014 Apr 24;370(17):1583-93. doi: 10.1056/NEJMoa1312173. Epub 2014 Mar 18.
PubMed 24635770De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL. Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med. 2002 Jul 1;166(1):98-104. doi: 10.1164/rccm.200109-016oc.
PubMed 12091178Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med. 2004 Sep;32(9):1825-31. doi: 10.1097/01.ccm.0000138558.16257.3f.
PubMed 15343008Vallee F, Mateo J, Dubreuil G, Poussant T, Tachon G, Ouanounou I, Payen D. Cutaneous ear lobe Pco(2) at 37 degrees C to evaluate microperfusion in patients with septic shock. Chest. 2010 Nov;138(5):1062-70. doi: 10.1378/chest.09-2690. Epub 2010 May 14.
PubMed 20472858Vallee F, Vallet B, Mathe O, Parraguette J, Mari A, Silva S, Samii K, Fourcade O, Genestal M. Central venous-to-arterial carbon dioxide difference: an additional target for goal-directed therapy in septic shock? Intensive Care Med. 2008 Dec;34(12):2218-25. doi: 10.1007/s00134-008-1199-0. Epub 2008 Jul 8.
PubMed 18607565
Study at a glance
From the registry record, last updated by the sponsor on 22 Oct 2018. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Transcutaneous-Arterial Carbon Dioxide Gradient Predicts Microcirculatory Dysfunction And The Development of Organ Failure After Cardiac Surgery
- ClinicalTrials.gov ID
- NCT02328846
- Acronym / sponsor ID
- 17872
- Conditions
- Bypass Complications
- Study type
- Observational
- Recruitment status
- WithdrawnReason stopped: Insufficient equipment
- Enrolment
- 0 participants (actual)
- Lead sponsor
- University of VirginiaUniversity, hospital or other
- Study start
- Jan 2018 (estimated)
- Primary completion
- Jan 2019 (estimated)
- Study completion
- Feb 2020 (estimated)
- First posted
- 31 Dec 2014 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Evaluation of the microcirculation is currently limited. Continual assessment of the tissue carbon dioxide-arterial carbon dioxide (PtC02-aCO2) offers a new, novel and noninvasive method of determining the state of the microcirculation. The investigators will apply two non-invasive devices, the Braedius sidesteam darkfield microscopy (SDF) microscopy device to the sublingual circulation and the transcutaneous PtC02 probe to the forehead in subjects undergoing cardiac surgery with cardiopulmonary bypass. The PtC02-aCO2 gradient will be determined and correlated with the videomicroscopic images of the sublingual microcirculation. Thereafter the incidence of postoperative organ failure and acute kidney injury will be determined and correlated with PtC02-arterial CO2 gradient and videomicroscopic images.
Data will be analyzed by standard descriptive statistical methods.
Detailed description
There is increasing evidence that despite resuscitation and normalization of macrohemodynamic parameters (blood pressure and cardiac output) significant dysfunction of the microcirculation may persist.1, 2 There is also a positive correlation between the severity of microcirculatory dysfunction and outcome in patients with septic shock. In contrast, early improvements in microcirculatory perfusion in response to macrohemodynamic goal directed therapy is associated with an improvement in organ function.3 Monitoring the microcirculation is challenging. The monitoring window (e.g. the sublingual bed) must be reflective of other remote vascular beds. This is more likely to be the case in the setting of systemic diseases such as sepsis and hypovolemic shock. Current research modalities for studying the microcirculation include laser Doppler and videomicroscopy.4 The limitation of these devices is that assessment of the microcirculation has to be performed off-line and targets for microvascular resuscitation have not been established. Therefore, microvascular monitoring is currently restricted to the research arena. Evaluation of the tissue transcutaneous carbon dioxide (PtC02) is a novel, non-invasive, real-time method of assessing the microcirculation.5, 6 The three major determinants of PtC02 are arterial carbon dioxide (PaCO2), oxygen consumption (VCO2) and the tissue blood flow. Under normal conditions, an increased tissue metabolism (thus VCO2) is coupled with an increased tissue perfusion, largely reducing any PtC02 increase ("washout" phenomenon). Therefore, if PaCO2 is constant, an increase in PtC02 reflects an inadequate relationship between metabolism and tissue perfusion. PtC02 thus represents a good estimate of tissue perfusion. To overcome the influence of PaCO2 on PtC02, it is convenient to use the carbon dioxide gap (tissue-arterial carbon dioxide gradient, normal<7 mmHg). Very high gap values may in addition suggest the presence of tissue hypoxia while moderately elevated gaps may represent either flow stagnation or tissue hypoxia. Cardiac surgery is characterized by significant alteration of the microvascular circulation. These changes are observed in both on-pump and off-pump cases and with pulsatile and non-pulsatile flow. Monitoring the PtC02-arterial CO2 gradient offers a rapid real-time measure of the microvascular abnormalities encountered during the post-cardiopulmonary bypass (CPB) period and their effect on post-CPB organ dysfunction.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Subjects undergoing cardiac surgery with cardiopulmonary bypass
Key inclusion criteria (3 listed)
- Age > 18 years
- Elective cardiac surgery
- Must be able to read and speak English
Key exclusion criteria (5 listed)
- Subjects unable/unwilling to give informed consent
- Emergency surgery
- Age < 18 years
- Pregnant females-self reported
- Prisoners
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Postoperative SOFA score
Time frame: Participants will be followed for the duration of ICU stay, an expected average of 1 weeks
1 secondary outcome
Postoperative Kidney Disease Improving Global Outcome (KDIGO) class
Time frame: Participants will be followed for the duration of ICU stay, an expected average of 1 weeks
Results and safety
The study was withdrawn before enrolling participants, so there are no results.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 22 Oct 2018.
- Results publication: PubMed 24635770Asfar P, Meziani F, Hamel JF, Grelon F, Megarbane B, Anguel N, Mira JP, Dequin PF, Gergaud S, Weiss N, Legay F, Le Tulzo Y, Conrad M, Robert R, Gonzalez F, Guitton C, Tamion F, Tonnelier JM, Guezennec P, Van Der Linden T, Vieillard-Baron A, Mariotte E, Pradel G, Lesieur O, Ricard JD, Herve F, du Cheyron D, Guerin C, Mercat A, Teboul JL, Radermacher P; SEPSISPAM Investigators. High versus low blood-pressure target in patients with septic shock. N Engl J Med. 2014 Apr 24;370(17):1583-93. doi: 10.1056/NEJMoa1312173. Epub 2014 Mar 18.
- Results publication: PubMed 12091178De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL. Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med. 2002 Jul 1;166(1):98-104. doi: 10.1164/rccm.200109-016oc.
- Results publication: PubMed 15343008Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med. 2004 Sep;32(9):1825-31. doi: 10.1097/01.ccm.0000138558.16257.3f.
- Results publication: PubMed 20472858Vallee F, Mateo J, Dubreuil G, Poussant T, Tachon G, Ouanounou I, Payen D. Cutaneous ear lobe Pco(2) at 37 degrees C to evaluate microperfusion in patients with septic shock. Chest. 2010 Nov;138(5):1062-70. doi: 10.1378/chest.09-2690. Epub 2010 May 14.
- Results publication: PubMed 18607565Vallee F, Vallet B, Mathe O, Parraguette J, Mari A, Silva S, Samii K, Fourcade O, Genestal M. Central venous-to-arterial carbon dioxide difference: an additional target for goal-directed therapy in septic shock? Intensive Care Med. 2008 Dec;34(12):2218-25. doi: 10.1007/s00134-008-1199-0. Epub 2008 Jul 8.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Bhiken I Naik, M.B.B.Ch principal investigator
University of Virginia
Questions about this trial
What is this clinical trial studying?
An observational study of Bypass Complications, run by University of Virginia.
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 3 inclusion and 5 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: withdrawn, as of the sponsor's last update on 22 Oct 2018. Status can change between updates, so confirm with the study contact before making plans.
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.
Are results available for this study?
The study was withdrawn before enrolling participants, so there are no results.
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?
Postoperative SOFA score (time frame: Participants will be followed for the duration of ICU stay, an expected average of 1 weeks). 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 NCT02328846, which also lists 5 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 22 Oct 2018.