Tight Perioperative Blood Pressure Management to Reduce Serious Cardiovascular, Renal, and Cognitive Complications: The GUARDIAN Trial (Induction Agent Sub-Study Comparing Etomidate and Propofol)
试验速览
- 阶段
- 4 期
- 状态
- Enrolling By Invitation
- 入组人数
- 6,254
- 试验地点
- 11
- 主要终点
- Number of Participants with a Composite of Major Perfusion-Related Complications
研究概览
简要总结
This is a sub-study of the overall GUARDIAN trial (NCT04884802) in which some GUARDIAN trial participants will be additionally randomized to etomidate vs propofol for anesthetic induction.
详细描述
Participants in the underlying GUARDIAN trial (NCT04884802) will be randomized to: 1) routine intraoperative blood pressure management (routine pressure management); or 2) norepinephrine or phenylephrine infusion to maintain intraoperative MAP ≥85 mmHg (tight pressure management). Participants in this sub-study will be additionally randomized to etomidate or propofol for induction of anesthesia.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Factorial
- 主要目的
- Prevention
- 盲法
- Double (Participant, Outcomes Assessor)
入排标准
- 年龄范围
- 45 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •At least 45 years old;
- •Scheduled for major noncardiac surgery expected to last at least 2 hours;
- •Having general anesthesia, neuraxial anesthesia, or the combination;
- •Expected to require at least overnight hospitalization (planned ICU admission is acceptable);
- •Are designated ASA physical status 2-4 (ranging from mild systemic disease through severe systemic disease that is a constant threat to life);
- •Expected to have direct intraoperative blood pressure monitoring with an arterial catheter;
- •Cared for by clinicians willing to follow the GUARDIAN protocol;
- •Subject to at least one of the following risk factors:
- •Age >65 years;
- •History of peripheral arterial disease;
- •History of coronary artery disease;
- •History of stroke or transient ischemic attack;
- •Serum creatinine >175 μmol/L (>2.0 mg/dl) within 6 months;
- •Diabetes requiring medication;
- •Current smoking or 15 pack-year history of smoking tobacco;
- •Scheduled for major vascular surgery;
- •Body mass index ≥35 kg/m2;
- •Preoperative high-sensitivity troponin T >14 ng/L or troponin I equivalent, defined as ≥15 ng/L (Abbott assay), 19 ng/L (Siemens assay, [Borges, unpublished]), or 25% of the 99% percentile for other assays - all within 6 months;
- •B-type natriuretic protein (BNP) >80 ng/L or N-terminal B-type natriuretic protein (NTProBNP) >200 ng/L within six months.
排除标准
- •Are scheduled for carotid artery surgery;
- •Are scheduled for intracranial surgery;
- •Are scheduled for partial or complete nephrectomy;
- •Are scheduled for pheochromocytoma surgery;
- •Are scheduled for liver or kidney transplantation;
- •Require preoperative intravenous vasoactive medications;
- •Have a condition that precludes routine or tight blood pressure management such as surgeon request for relative hypotension;
- •Require beach-chair positioning;
- •Have a documented history of dementia;
- •Have language, vision, or hearing impairments that may compromise cognitive assessments;
- •Have contraindications to norepinephrine or phenylephrine per clinician judgement;
- •Have previously participated in the GUARDIAN trial.
研究组 & 干预措施
Routine Blood Pressure Management and Propofol Induction
Propofol will be used as the anesthetic induction agent.
干预措施: Propofol Induction (Drug)
Routine Blood Pressure Management and Propofol Induction
Propofol will be used as the anesthetic induction agent.
干预措施: Routine Blood Pressure Management (Procedure)
Routine Blood Pressure Management and Etomidate Induction
Etomidate will be used as the anesthetic induction agent.
干预措施: Routine Blood Pressure Management (Procedure)
Routine Blood Pressure Management and Etomidate Induction
Etomidate will be used as the anesthetic induction agent.
干预措施: Etomidate Induction (Drug)
Tight Blood Pressure Management and Etomidate Induction
Etomidate will be used as the anesthetic induction agent.
干预措施: Tight Blood Pressure Management (Procedure)
Tight Blood Pressure Management and Etomidate Induction
Etomidate will be used as the anesthetic induction agent.
干预措施: Etomidate Induction (Drug)
Tight Blood Pressure Management and Propofol Induction
Propofol will be used as the anesthetic induction agent.
干预措施: Tight Blood Pressure Management (Procedure)
Tight Blood Pressure Management and Propofol Induction
Propofol will be used as the anesthetic induction agent.
干预措施: Propofol Induction (Drug)
结局指标
主要结局
Number of Participants with a Composite of Major Perfusion-Related Complications
时间窗: During the initial 30 days after major non-cardiac surgery
The primary outcome is a composite of major perfusion-related complications (myocardial injury, stroke, non-fatal cardiac arrest, Stage 2-3 acute kidney injury, deep or organ-space infection, sepsis, and death) in the 30 days after major non-cardiac surgery.
次要结局
- Number of Participants with Postoperative Delirium(During the initial 4 postoperative days)
研究者
Daniel Sessler
Professor
The University of Texas Health Science Center, Houston