Atrial Natriuretic Peptide in Assessing Fluid Status

Study Overview
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Brief Summary
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Biomarkers can play a significant role in fluid status assessment intraoperatively.

Detailed Description
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Routinely intraoperatively the fluid status assessment is based on central venous pressure and other parameters. Nevertheless, the minority of anesthesiologists use continous dynamic parameters like pulse pressure variation, stroke volume variation and other to manage fluid status. There's a fast acting biomarker that can help anesthesiologist to diagnose and manage the volemic status and possibly guide the infusion therapy better. Pro-ANP is a biomarker that reacts on atria strain and can be used in volemic status assessment in cardiac surgery patients.

Official Title
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Role of Atrial Natriuretic Peptide in Assessing of Fluid Status in Cardiac Surgery Patients

Conditions
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Fluid Overload, Fluid Loss, Volume Overload, Cardiac Disease, Cardiac Output, Low, Cardiac Output, High

Intervention / Treatment
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* Diagnostic Test: pro-ANP


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: CABG, one-, two valve repair/replacement, ascending aorta, aortic arch replacement, ASD/AVD closure, septal myectomy Exclusion Criteria: Atrial fibrillation, atrial flutter, frequent ventricular and supraventricular arrythmias EFLV < 50% Pulmonary hypertension > 2 st CKD > C3 (GFR < 30) Redo surgery Left atrium volume > 150 ml LV EDV > 250 ml

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cardiac surgery patients<br>After admission to OR and arterial catheter is placed the pro-ANP probe is obtained. After anesthesia induction, trachea intubation before Teboul' test pro-ANP is obtained At the end of Teboul' test when lower limbs are lifted 30 minutes of CPB End of CPB End of volume transition from CPB circuit to patient Before Teboul' test at the end of surgery End of Teboul' test when lower limbs are lifted | Diagnostic Test: pro-ANP<br>* pro-ANP samples and fluid status assessment with functional tests (Teboul test) will be used 8 times intraoperatively.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of patients with CI rise > 10% after PLR maneuver | 2 stages of Teboul test assessment | intraoperatively | 
| Number of patients with pro-ANP twofold raise by the end of surgery | To assess the atria strain and consequent rise of pro-ANP by the end of surgery | intraoperatively | 
| Number of patients with pro-ANP increase > 10% by the PLR maneuver | According to positive PLR the assessment of pro-ANP consequent raise | intraoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative complications | Total amount of various postoperative complications | up to 10 days | 
| Mortality | Mortality rate | up to 10 days | 
| Multiorgan failure | Number of more than 2 organs failure | up to 10 days | 
| Respiratory failure | Number of patients who require prolonged and/or repeated artificial lung ventilation | up to 10 days | 
| Renal failure | Number of patients who require extracorporeal detoxication | up to 10 days | 
| Heart failure | Need in medicamental cardiotonic support more than 1 day | up to 10 days | 
| Circulatory insufficiency | Need in medicamental vasopressor support more than 1 day | up to 10 days | 
| Infection rate | Number of patients who develop systemic infection and/or operation wound infection | up to 10 days | 
| Length of intensive care stay | Duration of summarized length in ICU, including readmission to ICU | up to 10 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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fluid responsiveness, fluid status, cardiac surgery, volemic status, pro-ANP, hemodynamic monitoring, functional test, teboul test, stroke volume variation, cardiac output