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    Clinical Trial Results:
    Perioperative Goal Directed Fluid Therapy during Esophageal Resection. A prospective randomized controlled open multi-centre trial to study the effect on postoperative complications

    Summary
    EudraCT number
    2011-000254-39
    Trial protocol
    SE  
    Global end of trial date
    30 Apr 2017

    Results information
    Results version number
    v1(current)
    This version publication date
    30 Apr 2024
    First version publication date
    30 Apr 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    2011-07-01 korr 121213
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01416077
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Region Östergötland
    Sponsor organisation address
    Universitetssjuhuset, Linköping, Sweden, 58183
    Public contact
    Lena Nilsson, Department of Anesthesia and Intensive Care, 46 0101031838, lena.nilsson@regionostergotland.se
    Scientific contact
    Lena Nilsson, Department of Anesthesia and Intensive Care, 46 0101031838, lena.nilsson@regionostergotland.se
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    30 Apr 2017
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    14 Oct 2015
    Global end of trial reached?
    Yes
    Global end of trial date
    30 Apr 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To test whether intraoperative fluid and catecholamin administration steered by stroke volume optimization measured by "pulse contour analysis" will result in fewer postoperative complications
    Protection of trial subjects
    Study approved by Ethics committee. Study participants protected from Swedish law.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Sep 2011
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Sweden: 59
    Worldwide total number of subjects
    59
    EEA total number of subjects
    59
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    23
    From 65 to 84 years
    36
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    After oral and written informed consent had been obtained adult patients scheduled for elective transthoracic oesophageal resection because of malignancy at University Hospital Linkoping or University Hospital Orebro were randomised.

    Pre-assignment
    Screening details
    Adult patients scheduled for elective transthoracic oesophageal resection because of malignancy were randomised. Exclusion criteria were emergency procedures, planned colonic interposition, ASA class 4 or 5 patients or those for whom more extensive cardiac monitoring was planned, significant aortic or mitral valve insuffiency

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Intervention
    Arm description
    Goal-directed fluid therapy guided by pulse contour analysis
    Arm type
    Experimental

    Investigational medicinal product name
    dobutamine
    Investigational medicinal product code
    C01CA07
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Initially 2,5µg/kg/min with the purpose to achieve cardiac index > 2,5 l/min/m2. Restrited by signs of cardiac ischemia or heart rate over 90 beats/min

    Investigational medicinal product name
    Volulyte
    Investigational medicinal product code
    23245
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous bolus use
    Dosage and administration details
    3 ml/kg (max 250 ml) as a bolus during 5 minutes. Wait for 5 minutes and evaluate change in heart stroke volume. If increased by more than 10%, repeat another bolus until no further increase over 10% in stroke volume or DO2i over 600 ml/min/m2.

    Arm title
    Control group
    Arm description
    the responsible anaesthetist deter- mined the fluid administration rate and use of vasocon- strictors and inotropes. Stroke volume and Cardiac Index were not measured.
    Arm type
    No intervention

    Investigational medicinal product name
    No investigational medicinal product assigned in this arm
    Number of subjects in period 1
    Intervention Control group
    Started
    30
    29
    Completed
    30
    29

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Intervention
    Reporting group description
    Goal-directed fluid therapy guided by pulse contour analysis

    Reporting group title
    Control group
    Reporting group description
    the responsible anaesthetist deter- mined the fluid administration rate and use of vasocon- strictors and inotropes. Stroke volume and Cardiac Index were not measured.

    Reporting group values
    Intervention Control group Total
    Number of subjects
    30 29 59
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
        Newborns (0-27 days)
    0
        Infants and toddlers (28 days-23 months)
    0
        Children (2-11 years)
    0
        Adolescents (12-17 years)
    0
        Adults (18-64 years)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    65 ( 7 ) 66 ( 10 ) -
    Gender categorical
    Units: Subjects
        Female
    6 8 14
        Male
    24 21 45

    End points

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    End points reporting groups
    Reporting group title
    Intervention
    Reporting group description
    Goal-directed fluid therapy guided by pulse contour analysis

    Reporting group title
    Control group
    Reporting group description
    the responsible anaesthetist deter- mined the fluid administration rate and use of vasocon- strictors and inotropes. Stroke volume and Cardiac Index were not measured.

    Primary: Postop complication after 5 days

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    End point title
    Postop complication after 5 days
    End point description
    Postoperative days 0 to 5
    End point type
    Primary
    End point timeframe
    Days
    End point values
    Intervention Control group
    Number of subjects analysed
    30
    29
    Units: number
    56
    33
    Statistical analysis title
    postop compl 5 days
    Comparison groups
    Intervention v Control group
    Number of subjects included in analysis
    59
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.1
    Method
    Chi-squared
    Confidence interval

    Primary: Postop complication after 30 days

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    End point title
    Postop complication after 30 days
    End point description
    Accumulated number of complication after surgery up to 30 days postoperatively
    End point type
    Primary
    End point timeframe
    Postop 0 to 30 days
    End point values
    Intervention Control group
    Number of subjects analysed
    30
    29
    Units: Number of complications
    124
    81
    Statistical analysis title
    Postop compl 30 days
    Comparison groups
    Intervention v Control group
    Number of subjects included in analysis
    59
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.1
    Method
    Chi-squared
    Confidence interval

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    o-30 days postoperatively
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    Prespecified list of
    Dictionary version
    korr 12121
    Reporting groups
    Reporting group title
    Intervention
    Reporting group description
    Goal-directed fluid therapy guided by pulse contour analysis

    Reporting group title
    Control group
    Reporting group description
    the responsible anaesthetist deter- mined the fluid administration rate and use of vasocon- strictors and inotropes. Stroke volume and Cardiac Index were not measured.

    Serious adverse events
    Intervention Control group
    Total subjects affected by serious adverse events
         subjects affected / exposed
    22 / 30 (73.33%)
    19 / 29 (65.52%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    Cardiac disorders
    Myocardial infarction
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 29 (3.45%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Bradycardia
         subjects affected / exposed
    5 / 30 (16.67%)
    0 / 29 (0.00%)
         occurrences causally related to treatment / all
    0 / 5
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    unconsciosness
         subjects affected / exposed
    0 / 30 (0.00%)
    1 / 29 (3.45%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Obstruction
         subjects affected / exposed
    6 / 30 (20.00%)
    9 / 29 (31.03%)
         occurrences causally related to treatment / all
    0 / 6
    0 / 9
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Anastomotic complication
         subjects affected / exposed
    14 / 30 (46.67%)
    7 / 29 (24.14%)
         occurrences causally related to treatment / all
    0 / 14
    0 / 7
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pleural effusion
         subjects affected / exposed
    21 / 30 (70.00%)
    12 / 29 (41.38%)
         occurrences causally related to treatment / all
    0 / 21
    0 / 12
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tracheal injury
         subjects affected / exposed
    1 / 30 (3.33%)
    1 / 29 (3.45%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    respiratory insuffiency
         subjects affected / exposed
    7 / 30 (23.33%)
    5 / 29 (17.24%)
         occurrences causally related to treatment / all
    0 / 7
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Seroma
         subjects affected / exposed
    1 / 30 (3.33%)
    1 / 29 (3.45%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sepsis
         subjects affected / exposed
    4 / 30 (13.33%)
    2 / 29 (6.90%)
         occurrences causally related to treatment / all
    0 / 4
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 1%
    Non-serious adverse events
    Intervention Control group
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    26 / 30 (86.67%)
    22 / 29 (75.86%)
    Cardiac disorders
    Pericardial fluid
         subjects affected / exposed
    1 / 30 (3.33%)
    0 / 29 (0.00%)
         occurrences all number
    1
    0
    Hypotension
         subjects affected / exposed
    10 / 30 (33.33%)
    7 / 29 (24.14%)
         occurrences all number
    10
    7
    Surgical and medical procedures
    Pain
         subjects affected / exposed
    1 / 30 (3.33%)
    3 / 29 (10.34%)
         occurrences all number
    1
    3
    Nervous system disorders
    Delirium
         subjects affected / exposed
    6 / 30 (20.00%)
    0 / 29 (0.00%)
         occurrences all number
    6
    0
    Blood and lymphatic system disorders
    Coagulation factor
         subjects affected / exposed
    7 / 30 (23.33%)
    5 / 29 (17.24%)
         occurrences all number
    7
    5
    Gastrointestinal disorders
    Paralytic ileus
         subjects affected / exposed
    6 / 30 (20.00%)
    3 / 29 (10.34%)
         occurrences all number
    6
    3
    Respiratory, thoracic and mediastinal disorders
    Atelectasis
         subjects affected / exposed
    11 / 30 (36.67%)
    5 / 29 (17.24%)
         occurrences all number
    11
    5
    Renal and urinary disorders
    Transient renal impairment
         subjects affected / exposed
    4 / 30 (13.33%)
    2 / 29 (6.90%)
         occurrences all number
    4
    2
    Infections and infestations
    Pneumonia or other minor infections
         subjects affected / exposed
    19 / 30 (63.33%)
    15 / 29 (51.72%)
         occurrences all number
    19
    15

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/30431499
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