Journal Article

Individualized hemodynamic optimization guided by indirect measurement of the respiratory exchange ratio in major surgery: study protocol for a randomized controlled trial (the OPHIQUE study)

El Amine, Younes, Lorne, Emmanuel, Fischer, Marc-Olivier, Dupont, Hervé, Moussa, Mouhamed, Bar, Stéphane, Descamps, Richard, Boivin, Pierre, Abou Arab, Osama, Guinot, Pierre-Grégoire

2020

Overview

Background Observational studies have suggested that a high respiratory exchange ratio (RER) is associated with the occurrence of postoperative complications. The study’s primary objective is to demonstrate that the incidence of postoperative complications is lower in an interventional group (patients monitored using a hemodynamic algorithm that incorporates the RER) than in a control group (treated according to standard practice). Methods We shall perform a prospective, multicenter, randomized, open-label, superiority trial of consecutive patients undergoing major noncardiac surgery (i.e., abdominal, vascular, and orthopedic surgery). The control group will be treated according to the current guidelines on standard hemodynamic care. The interventional group will be treated according to an algorithm based on the RER. The primary outcome will be the occurrence of at least one complication in the 7 days following surgery. The secondary outcomes will be the length of hospital stay, the total number of complications per patient, the 30-day mortality, the total intraoperative volume of fluids administered, and the Sequential [sepsis-related] Organ Failure Assessment (SOFA) score and laboratory data measured on postoperative days 1, 2, and 7. A total of 350 patients will be included. Discussion In the operating theater, the RER is potentially a continuously available, easy-to-read, indirect marker of tissue hypoperfusion and postoperative complications. If the RER does predict the occurrence of tissue hypoperfusion, it will help the physician to provide personalized hemodynamic management and limit the side effects associated with excessive hemodynamic optimization (volume overload, vasoconstriction, etc.). Trial registration ClinicalTrials.gov NCT03852147 . Registered on February 25, 2019

• Publisher: BioMed Central,Springer Nature B.V
• Subject: Abdomen / Anaerobic threshold / Anesthesiology / Biomedicine / Blood pressure / Clinical trials / Consent / Critical care / Equivalence Trials as Topic / Health Sciences / Hemodynamics / Humans / Life Sciences / Lung / Medicine / Medicine & Public Health / Metabolism / Mortality / Multicenter Studies as Topic / Optimization / Patients / Postoperative Complications - etiology / Prospective Studies / Randomized Controlled Trials as Topic / Statistics for Life Sciences / Study Protocol / Vascular surgery