Evidence map›Paper›PMID 28707021›Full record

Trial reportJournal of anesthesia2017

The response to Trendelenburg position is minimally affected by underlying hemodynamic conditions in patients with aortic stenosis.

Abraham Sonny, Daniel I Sessler, Jing You, Babak Kateby Kashy, Sheryar Sarwar, Akhil K Singh, Shiva Sale, Andrej Alfirevic, Andra E Duncan

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Journal of anesthesia, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01187329 (The Effect of the Hyperinsulinemic Normoglycemic Clamp on Myocardial Function and Utilization of Glucose), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
0.2field-weighted citation impact, top 40% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01187329 nacompletednot on this map

The Effect of the Hyperinsulinemic Normoglycemic Clamp on Myocardial Function and Utilization of Glucose

TypeinterventionalSponsorThe Cleveland ClinicRan2010 to 2013Enrolled100ConditionsHyperglycemia, Aortic Valve Replacement, Aortic Stenosis, Cardiac SurgeryArmshyperinsulinemic normoglycemic clamp (HNC), control group
3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 4 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 1 institution in 3 countries.

Abraham SonnyDivision of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, USA. absonny@gmail.com.ORCID http://orcid.org/0000-0002-2101-9849
Daniel I SesslerDepartment of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
Jing YouDepartment of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
Babak Kateby KashyDepartment of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
Sheryar SarwarDepartment of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
Akhil K SinghDepartment of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
Shiva SaleDivision of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH, USA.
Andrej AlfirevicDivision of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH, USA.
Andra E DuncanDivision of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH, USA.
Cleveland Clinic · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTrendelenburg positioning is commonly used to temporarily treat intraoperative hypotension. The Trendelenburg position improves cardiac output in normovolemic or anesthetized patients, but not hypovolemic or non-anesthetized patients. Therefore, the response to Trendelenburg positioning may vary depending on patient population or hemodynamic conditions. We thus tested the hypothesis that the effectiveness of the Trendelenburg position, as indicated by an increase in cardiac output, improves after replacement of a stenotic aortic valve. Secondarily, we evaluated whether measurements of left ventricular preload, systolic function, or afterload were associated with the response to Trendelenburg positioning.

methodsThis study is a secondary analysis of a clinical trial which included patients having aortic valve replacement (AVR) who were monitored with pulmonary artery catheters (NCT01187329). We examined changes in thermodilution cardiac output with Trendelenburg positioning before and after AVR. We also examined whether echocardiographic and hemodynamic measurements of preload, afterload, and systolic function were associated with changes in cardiac output during Trendelenburg positioning.

resultsThirty-seven patients were included. The median [IQR] cardiac output change with Trendelenburg positioning was -3% [-10%, 5%] before AVR versus +4% [-4%, 15%] after AVR. Estimated median difference in cardiac output with Trendelenburg was 5% (95% CI 1, 15%, P = 0.04) greater after AVR. The response to Trendelenburg positioning was largely independent of hemodynamic conditions.

conclusionThe response to Trendelenburg positioning improved following AVR, but by a clinically unimportant amount. The response to Trendelenburg positioning was independent of hemodynamic conditions.

Indexed as

Head-Down TiltAgedAortic ValveAortic Valve StenosisCardiac OutputEchocardiographyFemaleHeart Valve Prosthesis ImplantationHemodynamicsHumansHypovolemiaMaleMiddle AgedPatient PositioningSystoleThermodilutionAnesthesiaAortic stenosisAortic valve replacementCardiac surgeryTrendelenburg position

Identifiers

PMID28707021
OpenAlexW2736138840

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.