Study of Urethral Perfusion Index-Guided Blood Flow Management During Major Abdominal Surgery in Adults 45 and Older

What this Trial Is About

Researchers are evaluating whether maintaining the urethral perfusion index at or above the baseline measured after anesthesia induction improves intraoperative tissue perfusion during major abdominal surgery. This single-center pilot trial compares routine hemodynamic management to urethral perfusion index-guided management, using a randomized and single-blinded design. The study also explores the relationship between urethral perfusion index and other heart and peripheral perfusion measurements as planned substudies. Participants undergoing elective major abdominal surgery lasting at least 120 minutes will be randomly assigned to either routine care, where urethral perfusion index is measured but hidden from clinicians, or to a group where clinicians aim to keep the urethral perfusion index above the postinduction baseline during surgery. The index is monitored using the IKORUS System device. Interventions to maintain the index are at the clinicians discretion, while also maintaining standard macrocirculatory safety parameters such as blood pressure, heart rate, and cardiac index. During the surgery, researchers will continuously monitor the urethral perfusion index and related cardiovascular variables. The main measurement is the average intraoperative urethral perfusion index from the start to the end of surgery. Secondary outcomes include the lowest values, time spent below baseline, and related perfusion metrics. This monitoring aims to assess tissue perfusion and microcirculation under different management strategies, with participation lasting through the surgical procedure.

Urethral PeRfusion Index-Guided Hemodynamic ManagemenT in Patients Having Major Abdominal Surgery: the UPRIGHT Randomized Feasibility Trial