Effect of Diastolic Dysfunction on Dynamic Cardiac Monitors

University of California (UC) Davis

Status: Completed

Conditions: Diastolic Dysfunction; Stroke Volume Variation

Treatments: Other: Intravenous fluid administration; Procedure: Trans thoracic Ultrasound Examination

Study type: Observational

Funder types: Other

Identifiers

NCT04177225

1380344

Details and patient eligibility

About

This investigator initiated, prospective, observational, single-center study is designed to assess whether dynamic monitors of cardiac function such as stroke volume variation (SVV) that have been shown to predict volume responsiveness differ in clinical utility between patients with and without diastolic dysfunction.

Full description

This investigator initiated, prospective, observational, single-center study is designed to assess whether dynamic monitors of cardiac function, such as stroke volume variation (SVV), that have been shown to predict volume responsiveness differ in clinical utility between patients with and without diastolic dysfunction.

Specific Aims:

• Determine the threshold for the predictive response of SVV with respect to increasing cardiac output for patients with and without diastolic dysfunction.
• Compare the trans thoracic ultrasound assessment of left ventricular diastolic function before and after the induction of general anesthesia.

Enrollment: 120 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Patients Undergoing Elective surgical procedures where invasive arterial line pressure monitoring is a planned part of the intraoperative management
• Age greater than or equal to 18
• Procedures requiring general anesthesia and mechanical ventilation

Exclusion criteria

• Adults unable to provide consent
• Atrial Fibrillation or other significant active arrhythmia
• Emergency Procedures
• Hemodynamic instability requiring vasopressor and/or inotropic infusions
• Presence of an intra-aortic balloon pump
• Open thoracic procedures
• Extremes of BMI less than 20 or greater than 40
• Pregnancy
• Prisoners
• Patient Refusal

Trial design

120 participants in 2 patient groups

Patients with normal diastolic function

Description:

Patients undergoing scheduled surgical procedures requiring general anesthesia and invasive arterial pressure and advanced cardiac function monitoring. A trans thoracic ultrasound examination of cardiac function will be performed before induction of general anesthesia . In the operating room, the anesthesia care team will place all of the standard intra-operative monitors and then induce general anesthesia. After induction, the ultrasound examination will be repeated and the planned additional intra-operative monitors will be placed. The arterial catheter will be attached to a FloTrac/EV1000 monitor that will be used to guide fluid management during the procedure. The sensitivity and specificity of SVV to predict the response of cardiac output to intravenous fluid administration will be assessed in this patient group distinguished by their normal left ventricular diastolic function.

Treatment:

Procedure: Trans thoracic Ultrasound Examination

Other: Intravenous fluid administration

Patients with abnormal diastolic function

Description:

Patients undergoing scheduled surgical procedures requiring general anesthesia and invasive arterial pressure and advanced cardiac function monitoring. A trans thoracic ultrasound examination of cardiac function will be performed before induction of general anesthesia . In the operating room, the anesthesia care team will place all of the standard intra-operative monitors and then induce general anesthesia. After induction, the ultrasound examination will be repeated and the planned additional intra-operative monitors will be placed. The arterial catheter will be attached to a FloTrac/EV1000 monitor that will be used to guide fluid management during the procedure. The sensitivity and specificity of SVV to predict the response of cardiac output to intravenous fluid administration will be assessed in this patient group distinguished by their abnormal left ventricular diastolic function.

Treatment:

Procedure: Trans thoracic Ultrasound Examination

Other: Intravenous fluid administration