Oedema
Research type
Research Study
Full title
Study of changes of mean systemic filling pressure and functional capillary density after stroke volume maximisation in post-operative patients
IRAS ID
164918
Contact name
H.D. Aya
Contact email
Sponsor organisation
St George's University of London
Clinicaltrials.gov Identifier
14/LO/2047, REC reference number
Duration of Study in the UK
0 years, 4 months, 1 days
Research summary
The administration of fluids is an essential part of the haemodynamic resuscitation of post-operative patients. However, an excess of fluids can also cause harm. and is associated with poor outcomes in post-operative patients. Fluid overload can increase the interstitial volume (free fluid around the cells or oedema), which increases the distance between capillaries (microscopic blood vessels) and cells. In technical words, it is a reduction in functional capillary density (FCD). This impairs the oxygen diffusion to the cells and increases the risk of organ failure. Therefore it is crucial to find out the way to guide the fluid administration in critically ill patients without generating oedema.
Currently, fluid therapy is guided by the cardiac response to the infusion of IV fluids. A sequence of fluid challenges (bolus of IV fluid in a short period of time) is used until the cardiac response, measured by cardiac output (CO) or stroke volume (SV), is not increasing anymore. This is called SV maximisation. However, we do not know whether the SV maximisation may generate an increase in interstitial fluid (oedema).
On the other hand, the Pmsf can be used to quantify the intravascular volume status independently of cardiac function. Pmsf is like the pressure in a tyre. Then, we wonder if the SV maximisation increase the Pmsf to a level where the hydrostatic pressure in the blood vessels increase the leak of fluid to the interstitial space. If that were the case, Pmsf could be used to limit fluid therapy and avoid fluid overload.
As SV maximisation is part of our normal clinical practice, we want to observe Pmsf and FCD at base line and after SV maximisation in post-operative patients admitted to intensive care unit.REC name
London - Camden & Kings Cross Research Ethics Committee
REC reference
14/LO/2047
Date of REC Opinion
2 Dec 2014
REC opinion
Unfavourable Opinion