Working…
ClinicalTrials.gov
ClinicalTrials.gov Menu

Cerebral Oximetry in Single Lung Ventilation Thoracic Surgery

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT01866657
Recruitment Status : Unknown
Verified May 2013 by Edwin Avery, University Hospitals Cleveland Medical Center.
Recruitment status was:  Not yet recruiting
First Posted : May 31, 2013
Last Update Posted : May 31, 2013
Sponsor:
Information provided by (Responsible Party):
Edwin Avery, University Hospitals Cleveland Medical Center

Tracking Information
First Submitted Date  ICMJE May 12, 2013
First Posted Date  ICMJE May 31, 2013
Last Update Posted Date May 31, 2013
Study Start Date  ICMJE June 2013
Estimated Primary Completion Date July 2014   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: May 28, 2013)
  • The primary objective of this pilot study is to identify the most relevant clinical outcome variables which significantly diverge as a result of being randomized to the intervention cohort vs. the control cohort. [ Time Frame: One year ]
    The clinical endpoints are defined by the clinical outcome variables assessed and include relationship of assignment group and AUC of cerebral desats and their observed relationship to PACU/hospital/ICU LOS, AUC of mean arterial blood pressure, IV vasoactive drugs, intraop mLs urine/kg/hr in OR, red blood cell(RBC) transfusion, change in surgical procedure, intra/postop stroke/TIA/MI/afib/AUC glucose > 110 mg/dL, OR time, narcotic administered in the OR, volume of crystalloid/colloid administered in the OR, Anti-emetic meds administered in the OR, Surgical procedure performed, Time on single lung ventilation, Intraop Use of epidural catheter, aldrete PACU score, frequency/severity of N/V in the PACU/ICU, mech vent time in the PACU/ICU, need for postop skilled nursing facility/rehab hospital, need for hospital readmission, change in MMSE/CAM scores from baseline, change in renal fxn compared to baseline, return of bowel function time, postop infection, postop composite endpoint
  • Relationship of assignment group to PACU length of stay. [ Time Frame: One year ]
    Relationship of assignment group (i.e. control vs intervention group) to PACU LOS
  • Relationship of Area under the curve (AUC) of cerebral desaturations to PACU LOS [ Time Frame: One year ]
    Relationship of AUC of cerebral desats to PACU LOS
  • Relationship of assignment group to Hospital length of stay (HLOS) [ Time Frame: One Year ]
    Relationship of assignment group (i.e. control vs intervention group) to HLOS
  • Relationship of Area under the curve (AUC) of cerebral desaturations to HLOS [ Time Frame: One year ]
    Relationship of Area under the curve (AUC) of cerebral desaturations to HLOS
  • Relationship of assignment group to ICU LOS [ Time Frame: One year ]
    Relationship of assignment group to ICU LOS
  • Relationship of AUC cerebral desaturations to ICU LOS [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to ICU LOS
  • Relationship of assignment group to AUC of mean arterial blood pressure [ Time Frame: One Year ]
    Relationship of assignment group to AUC of mean arterial blood pressure
  • Relationship of AUC cerebral desaturations to AUC of mean arterial blood pressure [ Time Frame: One Year ]
    Relationship of AUC cerebral desaturations to AUC of mean arterial blood pressure
  • Relationship of assignment group to observed intraoperative mLs urine/kg/hr [ Time Frame: One year ]
    Relationship of assignment group to observed intraoperative mLs urine/kg/hr
  • Relationship of AUC cerebral desaturations to observed intraoperative mLs urine/kg/hr [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed intraoperative mLs urine/kg/hr
  • Relationship of assignment group to transfusion of red blood cells [ Time Frame: One year ]
    Relationship of assignment group to transfusion of red blood cells
  • Relationship of AUC cerebral desaturations to transfusion of red blood cells [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to transfusion of red blood cells
  • Relationship of assignment group to observed frequency of any change in surgical procedure [ Time Frame: One year ]
    Relationship of assignment group to observed frequency of any change in surgical procedure
  • Relationship of AUC cerebral desaturations to observed frequency of any change in surgical procedure [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed frequency of any change in surgical procedure
  • Relationship of assignment group to observed frequency of intraoperative or postoperative stroke [ Time Frame: One Year ]
    Relationship of assignment group to observed frequency of intraoperative or postoperative stroke
  • Relationship of AUC cerebral desaturations to observed frequency of intraoperative or postoperative stroke [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed frequency of intraoperative or postoperative stroke
  • Relationship of assignment group to observed frequency of transient ischemic attack [ Time Frame: One year ]
    Relationship of assignment group to observed frequency of transient ischemic attack
  • Relationship of AUC cerebral desaturations to observed frequency of transient ischemic attack [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed frequency of transient ischemic attack
  • Relationship of assignment group to observed frequency of myocardial infarction [ Time Frame: One year ]
    Relationship of assignment group to observed frequency of myocardial infarction
  • Relationship of AUC cerebral desaturations to observed frequency of myocardial infarction [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed frequency of myocardial infarction
  • Relationship of assignment group to observed frequency of atrial fibrillation [ Time Frame: One year ]
    Relationship of assignment group to observed frequency of atrial fibrillation
  • Relationship of AUC cerebral desaturations to observed frequency of atrial fibrillation [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed frequency of atrial fibrillation
  • Relationship of assignment group to observed frequency of AUC glucose > 110 mg/dL [ Time Frame: One year ]
    Relationship of assignment group to observed frequency of AUC glucose > 110 mg/dL
  • Relationship of AUC cerebral desaturations to observed frequency of AUC glucose > 110 mg/dL [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed frequency of AUC glucose > 110 mg/dL
  • Relationship of assignment group to observed operating room time [ Time Frame: One year ]
    Relationship of assignment group to observed operating room time
  • Relationship of AUC cerebral desaturations to observed operating room time [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed operating room time
  • Relationship of assignment group to observed amount of narcotic administered in the operating room [ Time Frame: One year ]
    Relationship of assignment group to observed amount of narcotic administered in the operating room
  • Relationship of AUC cerebral desaturations to observed amount of narcotic administered in the operating room [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed amount of narcotic administered in the operating room
  • Relationship of assignment group to observed volume of crystalloid/colloid administered in the operating room [ Time Frame: One year ]
    Relationship of assignment group to observed volume of crystalloid/colloid administered in the operating room
  • Relationship of AUC cerebral desaturations to observed volume of crystalloid/colloid administered in the operating room [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed volume of crystalloid/colloid administered in the operating room
  • Relationship of assignment group to observed amount of anti-emetic meds administered in the operating room [ Time Frame: One year ]
    Relationship of assignment group to observed amount of anti-emetic meds administered in the operating room
  • Relationship of AUC cerebral desaturations to observed amount of anti-emetic meds administered in the operating room [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed amount of anti-emetic meds administered in the operating room
  • Relationship of assignment group to reported surgical procedure performed [ Time Frame: One year ]
    Relationship of assignment group to reported surgical procedure performed
  • Relationship of AUC cerebral desaturations to reported surgical procedure performed [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to reported surgical procedure
  • Relationship of assignment group to observed time on single lung ventilation [ Time Frame: One year ]
    Relationship of assignment group to observed time on single lung ventilation
  • Relationship of AUC cerebral desaturations to observed time on single lung ventilation [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed time on single lung ventilation
  • Relationship of assignment group to observed use of epidural catheter [ Time Frame: One year ]
    Relationship of assignment group to observed use of epidural catheter
  • Relationship of AUC cerebral desaturations to observed use of epidural catheter [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed use of epidural catheter
  • Relationship of assignment group to observed post anesthesia care unit Aldrete score [ Time Frame: One year ]
    Relationship of assignment group to observed post anesthesia care unit Aldrete score
  • Relationship of AUC cerebral desaturations to observed post anesthesia care unit Aldrete score [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed post anesthesia care unit Aldrete score
  • Relationship of assignment group to observed frequency and severity of nausea/vomiting in the post anesthesia care unit/intensive care unit [ Time Frame: One year ]
    Relationship of assignment group to observed frequency and severity of nausea/vomiting in the post anesthesia care unit/intensive care unit
  • Relationship of AUC cerebral desaturations to observed frequency and severity of nausea/vomiting in the post anesthesia care unit/intensive care unit [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed frequency and severity of nausea/vomiting in the post anesthesia care unit/intensive care unit
  • Relationship of assignment group to observed duration of mechanical ventilation in the post anesthesia care unit/intensive care unit [ Time Frame: One year ]
    Relationship of assignment group to observed duration of mechanical ventilation in the post anesthesia care unit/intensive care unit
  • Relationship of AUC cerebral desaturations to observed duration of mechanical ventilation in the post anesthesia care unit/intensive care unit [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed duration of mechanical ventilation in the post anesthesia care unit/intensive care unit
  • Relationship of assignment group to observed need for postoperative discharge to skilled nursing/rehabilitation facility [ Time Frame: One year ]
    Relationship of assignment group to observed need for postoperative discharge to skilled nursing/rehabilitation facility
  • Relationship of AUC cerebral desaturations to observed need for postoperative discharge to skilled nursing/rehabilitation facility [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed need for postoperative discharge to skilled nursing/rehabilitation facility
  • Relationship of assignment group to observed need for hospital readmission [ Time Frame: One year ]
    Relationship of assignment group to observed need for hospital readmission
  • Relationship of AUC cerebral desaturations to observed need for hospital readmission [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed need for hospital readmission
  • Relationship of assignment group to observed change in CAM or MMSE scores from baseline [ Time Frame: One year ]
    Relationship of assignment group to observed change in CAM or MMSE scores from baseline
  • Relationship of AUC cerebral desaturations to observed change in CAM or MMSE scores from baseline [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed change in CAM or MMSE scores from baseline
  • Relationship of assignment group to observed change in renal function from baseline [ Time Frame: One year ]
    Relationship of assignment group to observed change in renal function from baseline
  • Relationship of AUC cerebral desaturations to observed change in renal function from baseline [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed change in renal function from baseline
  • Relationship of assignment group to observed time to return of bowel function time [ Time Frame: One year ]
    Relationship of assignment group to observed time to return of bowel function time
  • Relationship of AUC cerebral desaturations to observed time to return of bowel function time [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed time to return of bowel function time
  • Relationship of group assignment to any observed postoperative infection [ Time Frame: One year ]
    Relationship of group assignment to any observed postoperative infection
  • Relationship of AUC cerebral desaturations to any observed postoperative infection [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to any observed postoperative infection
  • Relationship of assignment group to observed time to wean from postoperative supplemental oxygen [ Time Frame: One year ]
    Relationship of assignment group to observed time to wean from postoperative supplemental oxygen
  • Relationship of AUC cerebral desaturations to observed time to wean from postoperative supplemental oxygen [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed time to wean from postoperative supplemental oxygen
  • Relationship of assignment group to observed incidence of postop morbidity composite endpoint (defined in description section below) [ Time Frame: One year ]
    Relationship of assignment group to observed incidence of postop morbidity composite endpoint (defined by having any 1 of the following: new onset afib, ≥Grade 2 PONV, HLOS≥4.5 days, PACU LOS≥2 hours, any infection, death, stroke, MI, greater 0.5 mg/dL increase in Cr or new need for renal dialysis, postop need for IV inotropes or vasoactive meds)
  • Relationship of AUC cerebral desaturations to observed incidence of postoperative morbidity composite endpoint (defined in description section below) [ Time Frame: One year ]
    Relationship of AUC cerebral desaturations to observed incidence of postoperative morbidity composite endpoint (defined by having any one of the following: new onset atrial fibrillation, ≥Grade 2 PONV, HLOS≥4.5 days, PACU LOS≥2 hours, any infectious complication, death, stroke, myocardial infarction, greater 0.5 mg/dL increase in creatinine or new need for renal dialysis, postoperative need for intravenous inotropes or vasoactive medications)
Original Primary Outcome Measures  ICMJE Same as current
Change History No Changes Posted
Current Secondary Outcome Measures  ICMJE
 (submitted: May 28, 2013)
  • Assess the frequency of cerebral desaturations in both cohorts by examining both the total number of patients experiencing any cerebral desaturation as well as the total number of events among patients experiencing any cerebral desaturation. [ Time Frame: one year ]
    Assess the frequency of cerebral desaturations in both the intervention and control cohorts by examining both the total number of patients experiencing any cerebral desaturation as well as the total number of events among patients experiencing any cerebral desaturation.
  • Adverse clinical events and serious adverse events overall and in each cohort [ Time Frame: one year ]
    Assess the frequency of adverse clinical events and serious adverse events overall and in each cohort
  • Perform a comprehensive assessment of the frequency and efficacy of predefined rSO2 desaturation mitigation interventions and their collective ability to affect the observed cerebral oximetry values. [ Time Frame: one year ]
    Perform a comprehensive assessment of the frequency and efficacy of predefined rSO2 desaturation mitigation interventions (e.g., increase MAP with IV vasoconstrictor or fluid bolus, normalize ETCO2, deepen anesthesia, etc.) and their collective ability to affect the observed cerebral oximetry values. This will allow determination of the average number of interventions required and those most commonly effective in mitigating desaturation.
  • Assess the interventional cohort's preoperative demographics and collected covariates for association with the ease or difficulty of mitigating observed cerebral desaturation events. [ Time Frame: one year ]
    Because mitigating cerebral desaturations involves increasing oxygen delivery to the tissue it is possible that there is a relationship between preoperative demographic/variables such as age, peripheral vascular disease, left ventricular dysfunction, COPD, etc. and the ability to effectively mitigate desaturations in that subjects with disease in these organ systems may be more resistant to responding to desaturation interventions.
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures
 (submitted: May 28, 2013)
  • • Logistic regression analysis to determine the most relevant AUCrSO2 desaturation value(s) associated with any detrimental clinical outcome(s) monitored in this study [ Time Frame: one year ]
    Logistic regression analysis to determine the most relevant AUCrSO2 desaturation value(s) associated with any detrimental clinical outcome(s) monitored in this study
  • Logistic regression analysis to determine the most relevant AUC blood pressure values associated with any detrimental clinical outcome(s) monitored in this study [ Time Frame: one year ]
    Logistic regression analysis to determine the most relevant AUC blood pressure values associated with any detrimental clinical outcome(s) monitored in this study
  • Comparison of baseline rSO2 values (room air and oxygen supplemented) to all collected clinical variables to assess for possibly significant associations [ Time Frame: One year ]
    Comparison of baseline rSO2 values (room air and oxygen supplemented) to all collected clinical variables to assess for possibly significant associations
  • Explore the potential impact of rSO2 monitoring on changing the surgical conduct of the procedure [ Time Frame: one year ]
    Explore the potential impact of rSO2 monitoring on changing the surgical conduct of the procedure
Original Other Pre-specified Outcome Measures Same as current
 
Descriptive Information
Brief Title  ICMJE Cerebral Oximetry in Single Lung Ventilation Thoracic Surgery
Official Title  ICMJE NIRS-Based Cerebral Oximetry Monitoring in Elderly Thoracic Surgical Patients Undergoing Single Lung Ventilation Procedures: A Single Center, Prospective, Randomized Controlled Pilot Study Assessing the Clinical Impact of NIRS-Guided Intervention
Brief Summary This is a prospective, randomized controlled pilot study of cerebral oximetry use in elderly patients undergoing thoracic surgical procedures that require the use of single lung ventilation. The hypothesis is that subjects randomized to open cerebral oximetry monitoring that have active intervention to mitigate observed desaturations will have measurable postoperative clinical outcome benefits when compared to the patients randomized to blinded cerebral oximetry monitoring with no active interventions to mitigate desaturations.
Detailed Description

Study Rationale The use of bi-frontal, near infrared spectrophotometry (NIRS) based cerebral oximetry monitoring has been demonstrated to result in improved clinical outcomes in both general surgery patients and cardiac surgical patients using prospective, randomized controlled trial methodology. Elderly thoracic surgical patients undergoing procedures that involve single lung ventilation may also stand to benefit from the application of intraoperative and early postoperative NIRS cerebral oximetry monitoring. Cerebral oximetry has not been established as a standard of care monitoring modality in this patient population, thus permitting the application of randomized, controlled testing methodology to assess the potential impact of this monitoring modality upon these patients.

Hypothesis and Objectives:

The primary hypothesis in this pilot study of elderly thoracic surgical patients undergoing procedures involving single lung ventilation (SLV) is that there will be a measurable and significant clinical benefit (as assessed by a broad range of postoperative clinical outcome measures) to the subjects randomized to the intervention cohort (open bi-frontal NIRS based cerebral oximetry monitoring with a standardized intervention protocol) vs. the control cohort (blinded bi-frontal NIRS based cerebral oximetry monitoring).

The primary objective of this pilot study is to identify the most relevant clinical outcome variables which significantly diverge as a result of being randomized to the intervention cohort vs. the control cohort so that a larger, multicenter, prospective, randomized controlled clinical trial can be designed to further test the primary hypothesis as stated in the preceding section. The subsequent larger, multicenter trial will be conducted to definitively demonstrate the ability of INVOS® 5100 guided NIRS-based bi-frontal monitoring to improve clinical outcomes in this surgical patient group and potentially establish a new U.S. Food and Drug Administration cleared indication for this monitoring modality. The clinical outcome variables being assessed as the primary objective are many and a detailed list of these variables can be found in the OUTCOME MEASURES - Primary Outcome Measure Section of this submission.

Secondary objectives of this pilot study include the following:

  1. Assess the frequency of cerebral desaturations in both the intervention and control cohorts by examining both the total number of patients experiencing any cerebral desaturation as well as the total number of events among patients experiencing any cerebral desaturation (of at least 5% below baseline and progressively larger desaturations). These analyses will be conducted on the entire study population as well as upon each cohort. The Area Under the Curve (AUC) analysis technique [incremental desaturation categories will be assessed based upon 5 to 50% decreases, measured in 5% increments, from established room air pre-incision baseline as well as oxygen supplemented pre-incision baseline as well as desaturations below absolute measured rSO2 values] will be employed to conduct these analyses.
  2. Assess the frequency of adverse clinical events and serious adverse events overall and in each cohort.
  3. Perform a comprehensive assessment of the frequency and efficacy of predefined rSO2 desaturation mitigation interventions and their collective ability to affect the observed cerebral oximetry values.
  4. Assess the interventional cohort's preoperative demographics and collected covariates for association with the ease or difficulty of mitigating observed cerebral desaturation events.

Exploratory analyses will include performing all possible comparisons of the two groups based upon all collected perioperative variables to examine the potentially significant relationships between the collected clinical variables representing surrogates of organ perfusion/function and cerebral oximetry desaturations (AUCrSO2). The following exploratory endpoints will be assessed:

  1. Logistic regression analysis to determine the most relevant AUCrSO2 desaturation value(s) associated with any detrimental clinical outcome(s) monitored in this study
  2. Logistic regression analysis to determine the most relevant AUC blood pressure values associated with any detrimental clinical outcome(s) monitored in this study
  3. Comparison of baseline rSO2 values (room air and oxygen supplemented) to all collected clinical variables to assess for possibly significant associations
  4. Explore the potential impact of rSO2 monitoring on changing the surgical conduct of the procedure Methodology: Single center, prospective, randomized, controlled clinical pilot study Number of Subjects: 100 subjects with balanced randomization (1:1) to control (blinded NIRS data) or intervention (open NIRS data) cohorts Main Criteria for Inclusion: Elderly patients (> 65 years of age) scheduled for a thoracic surgical procedure at UHCMC that will involve SLV.

Duration of Treatment: Cerebral oximetry monitoring will begin with an assessment of both room air and oxygen supplemented bi-frontal baseline NIRS values and continue through the surgery to either PACU discharge or the initial 12 hours of post surgical ICU treatment. Mini Mental Status exam testing and Delirium testing with the Confusion Assessment Method will occur preoperatively and postoperatively through post-operative day (POD) #3 (or discharge if that occurs sooner than POD #3). Enrolled subjects will be followed during the index hospitalization and will undergo a 30 day follow up telephone interview to assess their progress following hospital discharge.

Criteria for Evaluation:

A large number of intraoperative and postoperative clinical variables that include cerebral oximetry, pulse oximetry, blood pressure, a composite outcome measure and clinical variables representing organ function will be assessed with the primary endpoint being the determination of which clinical variables are improved, if any, as a result of being randomized to open NIRS data monitoring with a predefined desaturation intervention algorithm guideline. The Mini Mental Status exam and Confusion Assessment Method test will be used to determine if any measured clinical variables have an effect upon neuropsychological outcomes. The frequency and effectiveness of the various cerebral desaturation mitigating interventions will be assessed in the intervention cohort.

Additional Safety Observations:

The frequency and severity of adverse clinical events and serious adverse clinical events will be assessed to determine if the use of open NIRS data bi-frontal cerebral monitoring is associated with any significant change in the observation of such events.

Statistical Methods:

Preoperative demographics and clinical variables will be compared in the two groups to assess for significant differences using the independent t-test. Differences in the observed clinical data between groups will be determined with the Wilcoxon rank-sum test. Stepwise, forward, multivariable logistic regression analysis will be performed to assess for relationships between cerebral desaturations and any of the measured clinical variables with a p value < 0.05 being considered significant

Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Care Provider)
Primary Purpose: Treatment
Condition  ICMJE Hypoxia
Intervention  ICMJE
  • Drug: Vasoconstrictor Agents
    cerebral desaturations may be treated with IV vasoactives to increase blood pressure or cardiac output at attending physician's descretion.
    Other Name: phenylephrine, ephedrine, dopamine
  • Other: Head/neck repositioning
    Assure that arterial and venous neck blood flow is not obstructed related to patient positioning
    Other Name: neck repositioning
  • Other: Increase ETCO2
    Allow normalization or slight increase in end tidal CO2 to cause selective cerebral vasodilation and increased tissue blood flow/O2 delivery
    Other Name: Normalize end tidal CO2
  • Other: IV fluid bolus
    Administer IV fluids to increase preload and cardiac output
  • Drug: Additional anesthesia
    By deepening anesthetic there will be a decrease in cerebral metabolic oxygen consumption.
    Other Name: sevoflurane, propofol
  • Biological: RBC transfusion
    By administering RBCs there will be a increase in intravascular volume and cardiac preload and an increase in oxygen carrying capacity
  • Drug: Increase FiO2
    Increase FiO2 to improve oxygen delivery to tissue
    Other Name: Increase fractional concentration of inspired oxygen
Study Arms  ICMJE
  • Experimental: Intervention cohort
    Open cerebral oximetry monitoring; observed desaturations will be treated with an intervention algorithm including increase FiO2, head/neck repositioning,vasoconstrictor agents, IV fluid bolus, increase ETCO2, additional anesthesia, RBC transfusion.
    Interventions:
    • Drug: Vasoconstrictor Agents
    • Other: Head/neck repositioning
    • Other: Increase ETCO2
    • Other: IV fluid bolus
    • Drug: Additional anesthesia
    • Biological: RBC transfusion
    • Drug: Increase FiO2
  • No Intervention: Blinded cerebral oximetry monitoring
    These subjects will have continous cerebral oximetry monitoring like the experimental cohort but the values will be blinded to all clinicians and research staff. There will be no cerebral desaturation interventions in this group because the clinicians will not be aware of a desaturation as the monitor's output is blinded in this group.
Publications *

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Unknown status
Estimated Enrollment  ICMJE
 (submitted: May 28, 2013)
100
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE December 2014
Estimated Primary Completion Date July 2014   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  1. Any male or female patient ≥ 65 years of age and able to provide informed consent (or consent may be provided by a legally authorized representative) who is scheduled for a thoracic surgical procedure that is expected to involve the use of intraoperative single lung ventilation (SLV)
  2. Able to adequately complete a baseline mini-mental status examination (MMSE)
  3. Able to complete a baseline confusion assessment method (CAM) examination
  4. Able to obtain bi-frontal baseline rSO2 values prior to induction of anesthesia

Exclusion Criteria:

  1. Any patient who has participated in a clinical study of an investigational drug or device in the past 30 days
  2. Any patient who the principal investigator feels at any time or for any reason should not participate in this clinical study
  3. Withdrawal of informed consent for any reason
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 65 Years and older   (Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT01866657
Other Study ID Numbers  ICMJE UHCMC-CEROX-01
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product Not Provided
IPD Sharing Statement  ICMJE Not Provided
Responsible Party Edwin Avery, University Hospitals Cleveland Medical Center
Study Sponsor  ICMJE University Hospitals Cleveland Medical Center
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: John C Klick, MD University Hospitals Cleveland Medical Center
Study Director: Edwin G Avery, MD University Hospitals Cleveland Medical Center
PRS Account University Hospitals Cleveland Medical Center
Verification Date May 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP