title: The OPVI trial - perioperative hemodynamic optimization using the plethysmographic variability index in orthopedic surgery: study protocol for a multicenter randomized controlled trial.
abstract: BACKGROUND
  Hemodynamic optimization during surgery is of major importance to decrease postoperative morbidity and length of hospital stay. However, conventional cardiac output monitoring is rarely used at the bedside. Recently, the plethysmographic variability index (PVI) was described as a simplified alternative, using plug-and-play noninvasive technology, but its clinical utility remains to be established.
  
  
  METHODS
  The hemodynamic optimization using the PVI (OPVI) trial is a multicenter randomized controlled two-arm trial, randomizing 440 patients at intermediate risk of postoperative complications after orthopedic surgery. Hemodynamic optimization was conducted using either the PVI (PVI group) or conventional mean arterial pressure (control group). The anesthesiologist performed the randomization the day before surgery using an interactive web response system, available 24 hours a day, 7 days a week. The randomization sequence was generated using permutated blocks and stratified by center and type of surgery (knee or hip arthoplasty). Patients and surgeons, but not anesthesiology staff, were blinded to the allocation group. The primary outcome measure is the length of hospital stay following surgery. The attending surgeon, who was blinded to group assessment, determined hospital discharge. Secondary outcome measures are theoretical length of hospital stay, determined using a dedicated discharge-from-hospital checklist, postoperative arterial lactate level in the recovery room, postoperative troponin level, presence of serious postoperative cardiac complications, and postoperative acute kidney insufficiency.
  
  
  CONCLUSIONS
  The OPVI trial is the first multicenter randomized controlled study to investigate whether perioperative hemodynamic optimization using PVI during orthopedic surgery could decrease the length of hospital stay and postoperative morbidity.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02207296 .
authors.affiliation: Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000, Caen, France. fischer-mo@chu-caen.fr.|EA 4650, Université de Caen Basse-Normandie, Esplanade de la Paix, CS 14 032, F-14 000, Caen, France. fischer-mo@chu-caen.fr.
authors.forename: Marc-Olivier
authors.initials: MO
authors.lastname: Fischer
authors.affiliation: Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000, Caen, France. daccache-g@chu-caen.fr.
authors.forename: Georges
authors.initials: G
authors.lastname: Daccache
authors.affiliation: Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000, Caen, France. sand.lemoine2@wanadoo.fr.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Lemoine
authors.affiliation: Service d'Anesthésie Réanimation, CHRU de Lille, Hôpital Roger Salengro, Rue Emile Laine, 59 037, Lille, France. benoit.tavernier@chru-lille.fr.
authors.forename: Benoît
authors.initials: B
authors.lastname: Tavernier
authors.affiliation: Service d'Anesthésie Réanimation, CHU de Rouen, Hôpital Charles Nicolle, 1 rue de Germont, 76 031, Rouen, France. vincent.compere@chu-rouen.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Compère
authors.affiliation: Department of Orthopedic Surgery, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000, Caen, France. hulet-c@chu-caen.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Hulet
authors.affiliation: Service d'Anesthésie, Hôpital Saint Philibert, 115 rue du Grand But, F-59462, Lomme, France. bouchakour.chemseddine@ghicl.net.
authors.forename: Chems Eddine
authors.initials: CE
authors.lastname: Bouchakour
authors.affiliation: Service d'Anesthésie, Hôpital Saint Philibert, 115 rue du Grand But, F-59462, Lomme, France. canevet.christophe@ghicl.net.
authors.forename: Christophe
authors.initials: C
authors.lastname: Canevet
authors.affiliation: Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000, Caen, France. gerard-jl@chu-caen.fr.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Gérard
authors.affiliation: Department of Public Health, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000, Caen, France. guittet-l@chu-caen.fr.|INSERM1086, Faculty of Medicine, Caen University Hospital, Avenue de la Côte de Nacre, F-14032, Caen, France. guittet-l@chu-caen.fr.
authors.forename: Lydia
authors.initials: L
authors.lastname: Guittet
authors.affiliation: Anesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, F-80 054, Amiens, France. lorne.emmanuel@chu-amiens.fr.|INSERM ERI12, Jules Vernes University of Picardy, 12 rue des Louvels, F-80 000, Amiens, France. lorne.emmanuel@chu-amiens.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lorne
authors.affiliation: Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000, Caen, France. hanouz-jl@chu-caen.fr.|EA 4650, Université de Caen Basse-Normandie, Esplanade de la Paix, CS 14 032, F-14 000, Caen, France. hanouz-jl@chu-caen.fr.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Hanouz
authors.affiliation: Department of Biostatistics and Clinical Research, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000, Caen, France. parienti-jj@chu-caen.fr.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Parienti
mesh_terms: D000465:Algorithms; D000768:Anesthesia, General; D062186:Arterial Pressure; D002302:Cardiac Output; D057189:Checklist; D005602:France; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay; D016343:Monitoring, Intraoperative / Q000379:methods*; D019637:Orthopedic Procedures / Q000009:adverse effects; D010351:Patient Discharge; D010991:Plethysmography; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control; D011237:Predictive Value of Tests; D012307:Risk Factors; D012815:Signal Processing, Computer-Assisted; D013997:Time Factors; D016896:Treatment Outcome