Correlation Between Internal Jugular Vein Ultrasound and Electrical Cardiometry
Condition: Coronary Bypass Stenosis; Coronary Artery Bypass Grafting Surgery
Study type: Interventional

Summary: 
      Coronary artery bypass graft (CABG) surgery is one of the most frequently performed cardiac
      surgery procedures worldwide. CABG has been used for more than 40 years to relieve symptoms
      and to reduce the risk of death in patients with ischemic heart disease.
    

Detailed description: 
      Cardiopulmonary bypass can produce changes in fluid physiology and fluid responsiveness in
      patients characterized by increased interstitial fluid as a consequence of decreased cardiac
      output and inflammatory changes. This shift of fluid from intravascular space to the
      intrtstitial space, in addition to blood and fluid losses during the surgical procedure can
      result in an intravascular hypovolemia that requires fluid resuscitation.

      Fluid management is one of the most important treatments for stabilizing hemodynamics in
      patients during and after cardiac surgery. Hypovolemia may leads to inadequate organ
      perfusion, whereas fluid overload may lead to postoperative complications such as congestive
      heart failure or pulmonary edema, In addition to patients who underwent cardiac surgery have
      a certain degree of myocardial stunning and hence cautions should be taken regarding fluid
      management in patients with limited cardiac reserve.

      Fluid responsiveness (FR) is generally defined as an increase of 10-15% in stroke volume
      (SV), cardiac output (CO), or cardiac index (CI) in response to volume expansion and
      indicates unmasked hypovolemia or preload dependacy.

      The methods for assessing fluid responsiveness have been evolved from static and volume
      parameters such as central venous pressure (CVP), pulmonary artery occlusion pressure (PAOP),
      inferior vena cava (IVC) and superior vena cava (SVC) diameters, right ventricular
      end-diastolic volume and right ventricular end-diastolic volume, which are unable to predict
      fluid responsiveness to dynamic indices such as pulse pressure variation (PPV),stroke volume
      variation (SVV), Pleth variability index (PVI) and aortic blood flow which is based on
      heart-lung interactions during mechanical ventilation, which have amodest degree of accuracy.

      Techniques based on either a virtual or real fluid challenge such as passive led raising
      (PLR) and rapid fluid challenge (100-250cc) have a high degree of accuracy in predicting
      fluid responsiveness.

      Over the last decade, a number of studies have used heart-lung interactions during mechanical
      ventilation to assess fluid responsiveness; specifically pulse pressuer variation (PPV)
      derived from analysis of the arterial blood pressure wave form, stroke volume variation (SVV)
      derived from pulse-contour analysis (measured by lithium dilution cardiac output monitoring
      system (LiDDCO) or pulse index continuous cardiac output monitoring system (PiCCO), and the
      variation of the amplitude of the pulse oximter plethysmographic waveform have been shown to
      be highly predictive of fluid responsiveness.

      However, dynamic parameters are unreliable during spontaneous breathing activity. To overcome
      the limited accuracy of these hemodynamic parameters in this specific clinical scenario, a
      passive leg raising (PLR) manoeuver has been suggested to be reliable predictor of fluid
      responsiveness during spontaneous breathing.

      SVV can be monitored with the PiCCO system requiring transpulmonary thermodilution,It is an
      invasive procedure requires the venous access and balloon flotation of the catheter through
      the right side.

      Accordingly, there are complications associated with detection with this system, and some are
      even fatal. Furthermore, this system requires an elaborate protocol for intermittent
      injections into pulmonary artery catheter thermodilution.
    

Intervention name(s): Coronary Artery Bypass Grafting surgery
Intervention type(s): Procedure
Intervention description(s): Assessing the reliability of predicting fluid responsiveness in adults undergoing coronary artery bypass graft surgery using ultrasonography of the internal jugular vein for assessment of vessel distensibilty in relation to stroke volume variation (SVV) measured by electrical cardiometry.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment