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Donor HepatectomyNCT04733547

Spectral Analysis of Central Venous Pressure Waveform

An observational study of Donor Hepatectomy and Central Venous Catheter, run by JongHae Kim at 1 site in South Korea.

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

The use of central venous pressure has been abandoned for the assessment of intravascular volume status. The dynamic fluctuation of central venous pressure according to heart rate is quantitatively measured by spectral analysis of the central venous pressure waveform. Read more about this study

Who is it for?
Ages 20 to 60 years
What is being tested?
Placement of a central venous catheter, Monitoring of central venous pressure and Furosemide-induced hypovolemia before graft procurement
How many people
60 participants
Where
1 siteSouth Korea
Study dates
22 Feb 2021to 29 Nov 2023
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 20 to 60 years
  • All sexes
  • No healthy volunteers
  • Adult

Study population: Patients are recruited from a tertiary university hospital

Who may be able to join

  • American Society of Anesthesiologists physical status 1
  • Scheduled for donor hepatectomy under general anesthesia

Who cannot join

  • Arrhythmia
  • Valvular heart disease
  • Coronary artery disease
  • Cerebrovascular disease
  • Hypertension
  • Diabetes mellitus
Show all 14Show fewer
  • Renal insufficiency
  • Pulmonary problems
  • Any type of liver disease
  • Body mass index greater than 35 kg/m2
  • Human immunodeficiency virus infection
  • Psychosocial problems
  • Electrolyte imbalance
  • Reoperation

Trial locations and contacts

1 site in 1 country.

South Korea1 site
  • Daegu Catholic University Medical Center

    Daegu, 42472

Other trials in South Korea

About this study

Official title: Spectral Analysis of Central Venous Pressure Waveform in Patients Undergoing Donor Hepatectomy

The use of central venous pressure has been abandoned for the assessment of intravascular volume status. The dynamic fluctuation of central venous pressure according to heart rate is quantitatively measured by spectral analysis of the central venous pressure waveform. Its clinical utility in the assessment of intravascular volume status is investigated.

Read the detailed description

The use of central venous pressure, which is one of the static preload indices, has been abandoned for the assessment of intravascular volume status because of its unreliability. The static preload indices have been replaced with dynamic preload indices, such as stroke volume variation or pulse pressure variation because the dynamic preload indices reliably predict fluid responsiveness and perform better than the static preload indices. However, the periodic component of central venous pressure, which goes with cardiac cycles, has not been investigated. The power corresponding to heart rate from spectral analysis of central venous pressure waveform represents the extent of the dynamic fluctuation of central venous pressure and is assumed to reflect intravascular volume status. It is hypothesized that the spectral power of central venous pressure corresponding to heart rate represents intravascular volume status.

Being tested
Placement of a central venous catheter, Monitoring of central venous pressure, Furosemide-induced hypovolemia before graft procurement, Replacement of fluid loss after graft procurement, Monitoring of stroke volume variation
Medical subject headings
Hypovolemia

What participants receive

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

  • Placement of a central venous catheterProcedure or surgery

    The right internal jugular vein is located at the first rib level under ultrasound-guidance. Using an out-of-plane technique, a needle is introduced into the lumen of the vessel. The aspiration of blood into the syringe connected to the hub of the needle confirms the placement of the needle tip in the lumen. After the syringe is detached from the needle, a guidewire is advanced into the vessel lumen through the needle. A dilator is introduced over the guidewire and subsequently is removed. Then, a central venous catheter is introduced over the guidewire into the vessel lumen through the pathway expanded by the dilator. The catheter tip is placed in the superior vena cava by inserting the catheter as far as the distance between the edge of the right transverse process of the first thoracic vertebra and the carina, which is preoperatively measured on a posteroanterior chest radiograph.

  • Monitoring of central venous pressureDevice

    Following the placement of a central venous catheter, a fluid-filled system for monitoring central venous pressure is connected to the proximal lumen of the catheter. The reference transducer is placed at the level of 4/5 of the anteroposterior diameter of the thorax.

  • Furosemide-induced hypovolemia before graft procurementDrug

    Patients fast from 10 pm the day before surgery. On the arrival at the operating room, an intravenous catheter for Plasmalyte infusion is placed into the right cephalic or basilic vein. The distal lumen of the central venous catheter is used for the infusion of 6% hydroxyethyl starch. Fluid requirements due to anesthesia, surgery, and no per os intake are not replaced by minimizing the administration of the fluids. Five minutes after the collection of the baseline data, 20 mg of furosemide is administered to promote diuresis for facilitating the venous outflow of the liver. An additional dose of furosemide 20 mg is given if the urine output is <1 ml/kg within 30 minutes after the first dose. Unless the second dose of furosemide produces >1 ml/kg of urine within 30 minutes, 40 mg of furosemide is administered. In the absence of effective diuresis (1 ml/kg within 30 minutes after each dose), the use of furosemide is abandoned and the patients are excluded from the study.

  • Replacement of fluid loss after graft procurementDrug

    Immediately after the graft procurement, 500 ml of 6% hydroxyethyl starch are infused over 25 minutes. Afterward, Plasmalyte is infused at a rate of 10 ml/min until the end of surgery.

  • Monitoring of stroke volume variationDevice

    Following anesthesia induction, the right radial artery is catheterized. The catheter is connected to the EV1000 monitor (Edwards Lifesciences, Irvine, CA) through the FloTrac transducer (Edwards Lifesciences). The transducer is level with the one for central venous pressure monitoring. Using pulse contour analysis without external calibration, the stroke volume for each heartbeat is measured. At a 20-second interval, stroke volume variation is calculated as (maximum stroke volume - minimum stroke volume)/mean stroke volume.

Study groups in NCT04733547
Study groupRoleWhat they receive
Donor hepatectomyLive donors undergoing hepatectomy
Receives: Procedure: Placement of a central venous catheter; Device: Monitoring of central venous pressure; Drug: Furosemide-induced hypovolemia before graft procurement; Drug: Replacement of fluid loss after graft procurement; Device: Monitoring of stroke volume variation

What is being measured

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

  1. Spectral power of central venous pressure corresponding to heart rate during 5 minutes before graft procurement

    A band-pass filter (0.15-3 Hz) is applied to the 5 minute-long segment. The 5 minute-long segments are divided into 100 second-long segments overlapping 50% with each adjacent segment. Each segment is submitted to fast Fourier transformation. The spectral powers obtained from the periodograms of each segment are averaged. The integrated area corresponding to heart rate is the spectral power corresponding to heart rate.

    Measured: During 5 minutes before graft procurement

Secondary outcomes (20)
  1. Spectral powers of central venous pressure corresponding to respiratory rate and heart rate during 5 minutes before the first dose of furosemide

    A band-pass filter (0.15-3 Hz) is applied to the 5 minute-long segment. The 5 minute-long segments are divided into 100 second-long segments overlapping 50% with each adjacent segment. Each segment is submitted to fast Fourier transformation. The spectral powers obtained from the periodograms of each segment are averaged. The integrated areas corresponding to respiratory rate and heart rate are the spectral powers corresponding to respiratory rate and heart rate.

    Measured: During 5 minutes before the first dose of furosemide

  2. Spectral powers of central venous pressure corresponding to respiratory rate and heart rate between 30 and 35 minutes after surgical incision

    A band-pass filter (0.15-3 Hz) is applied to the 5 minute-long segment. The 5 minute-long segments are divided into 100 second-long segments overlapping 50% with each adjacent segment. Each segment is submitted to fast Fourier transformation. The spectral powers obtained from the periodograms of each segment are averaged. The integrated areas corresponding to respiratory rate and heart rate are the spectral powers corresponding to respiratory rate and heart rate.

    Measured: Between 30 and 35 minutes after surgical incision

  3. Spectral power of central venous pressure corresponding to respiratory rate during 5 minutes before graft procurement

    A band-pass filter (0.15-3 Hz) is applied to the 5 minute-long segment. The 5 minute-long segments are divided into 100 second-long segments overlapping 50% with each adjacent segment. Each segment is submitted to fast Fourier transformation. The spectral powers obtained from the periodograms of each segment are averaged. The integrated area corresponding to respiratory rate is the spectral power corresponding to respiratory rate.

    Measured: During 5 minutes before graft procurement

  4. Spectral powers of central venous pressure corresponding to respiratory rate and heart rate during 5 minutes after administration of 6% hydroxyethyl starch

    A band-pass filter (0.15-3 Hz) is applied to the 5 minute-long segment. The 5 minute-long segments are divided into 100 second-long segments overlapping 50% with each adjacent segment. Each segment is submitted to fast Fourier transformation. The spectral powers obtained from the periodograms of each segment are averaged. The integrated areas corresponding to respiratory rate and heart rate are the spectral powers corresponding to respiratory rate and heart rate.

    Measured: During 5 minutes after administration of 6% hydroxyethyl starch

  5. Stroke volume variation during 5 minutes before the first dose of furosemide

    The median of the values calculated at a 20-second interval

    Measured: During 5 minutes before the first dose of furosemide

  6. Stroke volume index during 5 minutes before the first dose of furosemide

    The median of the values calculated at a 20-second interval

    Measured: During 5 minutes before the first dose of furosemide

  7. Cardiac index during 5 minutes before the first dose of furosemide

    The median of the values calculated at a 20-second interval

    Measured: During 5 minutes before the first dose of furosemide

  8. Stroke volume variation between 30 and 35 minutes after surgical incision

    The median of the values calculated at a 20-second interval

    Measured: Between 30 and 35 minutes after surgical incision

  9. Stroke volume index between 30 and 35 minutes after surgical incision

    The median of the values calculated at a 20-second interval

    Measured: Between 30 and 35 minutes after surgical incision

  10. Cardiac index between 30 and 35 minutes after surgical incision

    The median of the values calculated at a 20-second interval

    Measured: Between 30 and 35 minutes after surgical incision

  11. Stroke volume variation during 5 minutes before graft procurement

    The median of the values calculated at a 20-second interval

    Measured: During 5 minutes before graft procurement

  12. Stroke volume index during 5 minutes before graft procurement

    The median of the values calculated at a 20-second interval

    Measured: During 5 minutes before graft procurement

  13. Cardiac index during 5 minutes before graft procurement

    The median of the values calculated at a 20-second interval

    Measured: During 5 minutes before graft procurement

  14. Stroke volume variation during 5 minutes after administration of 6% hydroxyethyl starch

    The median of the values calculated at a 20-second interval

    Measured: During 5 minutes after administration of 6% hydroxyethyl starch

  15. Stroke volume index during 5 minutes after administration of 6% hydroxyethyl starch

    The median of the values calculated at a 20-second interval

    Measured: During 5 minutes after administration of 6% hydroxyethyl starch

  16. Cardiac index during 5 minutes after administration of 6% hydroxyethyl starch

    The median of the values calculated at a 20-second interval

    Measured: During 5 minutes after administration of 6% hydroxyethyl starch

  17. Total dose of furosemide

    The total dose of furosemide used for the promotion of diuresis

    Measured: At graft procurement

  18. Urine output at graft procurement

    The total amount of urine output between the placement of urinary catheter and graft procurement

    Measured: At graft procurement

  19. Total urine output at the end of surgery

    The total amount of urine output at the end of surgery

    Measured: At the end of surgery

  20. Intraoperative blood loss

    Calculated as blood loss (ml) = [estimated blood volume*(preoperative hematocrit-postoperative hematocrit)]/mean between the 2 hematocrit values, where estimated blood volume (ml) = weight(kg)^0.425*height(cm)^0.725*0.007184*2217+age(years)*1.06 for female and weight(kg)^0.425*height(cm)^0.725*0.007184*3064-825 for male

    Measured: 1 day 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 posted2 Feb 2021
  2. Study start22 Feb 2021
  3. Primary completion29 Nov 2023
  4. Study completion29 Nov 2023

Resources

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
60 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04733547
Sponsor's protocol ID
CR-21-007
Status last verified
Dec 2023
First submitted
26 Jan 2021
Last updated
19 Dec 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Alian AA, Galante NJ, Stachenfeld NS, Silverman DG, Shelley KH. Impact of lower body negative pressure induced hypovolemia on peripheral venous pressure waveform parameters in healthy volunteers. Physiol Meas. 2014 Jul;35(7):1509-20. doi: 10.1088/0967-3334/35/7/1509. Epub 2014 Jun 5.

    PubMed 24901895
  • Hocking KM, Sileshi B, Baudenbacher FJ, Boyer RB, Kohorst KL, Brophy CM, Eagle SS. Peripheral Venous Waveform Analysis for Detecting Hemorrhage and Iatrogenic Volume Overload in a Porcine Model. Shock. 2016 Oct;46(4):447-52. doi: 10.1097/SHK.0000000000000615.

    PubMed 27070329
  • Hocking KM, Alvis BD, Baudenbacher F, Boyer R, Brophy CM, Beer I, Eagle S. Peripheral i.v. analysis (PIVA) of venous waveforms for volume assessment in patients undergoing haemodialysis. Br J Anaesth. 2017 Dec 1;119(6):1135-1140. doi: 10.1093/bja/aex271.

    PubMed 29028929
  • Sileshi B, Hocking KM, Boyer RB, Baudenbacher FJ, Kohurst KL, Brophy CM, Eagle S. Peripheral venous waveform analysis for detecting early hemorrhage: a pilot study. Intensive Care Med. 2015 Jun;41(6):1147-8. doi: 10.1007/s00134-015-3787-0. Epub 2015 Apr 11. No abstract available.

    PubMed 25862041

Questions about this trial

What is this clinical trial studying?

An observational study of Donor Hepatectomy and Central Venous Catheter, run by JongHae Kim at 1 site in South Korea.

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 14 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 Dec 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in South Korea. 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.

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?

Spectral power of central venous pressure corresponding to heart rate during 5 minutes before graft procurement (time frame: During 5 minutes before graft procurement). 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 NCT04733547, which also lists 4 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 Dec 2023.

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