{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T11:39:32Z","timestamp":1792496372544,"version":"4.5.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:00:00Z","timestamp":1774656000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Hamburg-Eppendorf (UKE)"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Trials"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intraoperative hemodynamic management is intended to ensure adequate tissue perfusion and oxygen delivery and eventually help avoid organ injury. However, the optimal strategy for intraoperative hemodynamic management in patients having non-cardiac surgery remains unclear. We here report the protocol of a trial designed to test the hypothesis that personalized intraoperative hemodynamic management targeting preoperative baseline cardiac index reduces the incidence of a composite outcome of major postoperative complications and death within 7\u00a0days after surgery compared to routine hemodynamic management in high-risk patients having elective\u00a0major abdominal surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The PELICAN trial is an international multicenter randomized trial in 1,128 high-risk patients having elective major abdominal surgery. The individual preoperative baseline cardiac index is determined with the patient being awake and resting in the supine position using noninvasive bioreactance. Patients are randomized to personalized hemodynamic management (intervention) or to routine hemodynamic management (control) during surgery. In patients assigned to personalized hemodynamic management, intraoperative cardiac index is maintained at least at the preoperative baseline cardiac index. In patients assigned to routine hemodynamic management, it is performed as per anesthesiologist preference (with blinded cardiac index monitoring). The primary outcome is the incidence of a composite outcome (\u201cany event versus none\u201d) of acute kidney injury, acute myocardial injury\u00a0(including myocardial infarction), non-fatal cardiac arrest, severe infectious complications, and death within 7\u00a0days after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Our trial will determine whether personalized intraoperative hemodynamic management targeting preoperative baseline cardiac index reduces the incidence of major postoperative complications and death within 7\u00a0days in high-risk patients having elective major abdominal surgery compared to routine hemodynamic management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov Identifier NCT05648279. Registered on 5\u00a0December 2022.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13063-026-09657-9","type":"journal-article","created":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T05:27:11Z","timestamp":1774675631000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Personalized hemodynamic management targeting preoperative baseline cardiac index in high-risk patients having major abdominal surgery: rationale and design of the international multicenter randomized PELICAN trial"],"prefix":"10.1186","volume":"27","author":[{"given":"Moritz","family":"Flick","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eske Kvanner","family":"Aasvang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Eichlseder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Klimovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes S.","family":"Meidert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian Sylvest","family":"Meyhoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Roth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Steinhaus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rune","family":"Sort","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Vives","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Vojnar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Ziemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Krause","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eik","family":"Vettorazzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Zapf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Kouz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Saugel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,28]]},"reference":[{"issue":"7","key":"9657_CR1","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1097\/EJA.0000000000000778","volume":"35","author":"MA Chong","year":"2018","unstructured":"Chong MA, Wang Y, Berbenetz NM, McConachie I. 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The primary ethics approval was obtained from the ethics committee Hamburg (Ethikkommission der \u00c4rztekammer Hamburg, Hamburg, Germany) on 15 December 2022 (registration number 2022\u2013100955-BO-ff). Each participating center obtained secondary approval from their respective ethics committees before initiating patient recruitment, ensuring compliance with local regulatory requirements. All participating patients must provide written informed consent, obtained by dedicated trial personnel before inclusion. Across all sites, potential participants are identified during preoperative assessment in the days preceding surgery, after which trained staff approach eligible individuals to discuss the trial. Patients receive ethically approved written information and consent documents in their native language and are given sufficient time to review materials, ask questions, and consult with family or physicians. Consent must be signed before any trial-specific procedures, including preoperative baseline cardiac index measurement. Patients are informed that they may withdraw at any time without consequences for their clinical care. Completed consent forms are stored securely in compliance with data protection requirements and Good Clinical Practice. Site initiation visits include dedicated training to ensure uniform conduct of the consent process across centers.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"MF is a consultant for Edwards Lifesciences (Irvine, CA, USA) and Vygon (Ecouen, France). MF has received honoraria for consulting and giving lectures from CNSystems Medizintechnik (Graz, Austria).EKA founder of spin-out company, WARD24\/7 ApS, Copenhagen, Denmark, with the aim of pursuing the regulatory and commercial activities of the WARD-project (developing a clinical support system for continuous wireless monitoring of vital signs). WARD24\/7 ApS has obtained license agreement for any WARD-project software and patents. One patent has been filed: \u201cWireless Assessment of Respiratory and circulatory Distress (WARD), EP 21184712.4 and EP 21205557.8\u201d.ME has no conflict of interest to declare.AK received honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA).ASM has received speaker honoraria from Edwards Lifesciences (Irvine, CA, USA).CSM: founder of a spin-out company, WARD24\/7 ApS, with the aim of pursuing the regulatory and commercial activities of the WARD-project (Wireless Assessment of Respiratory and circulatory Distress, a project developing a clinical support system for continuous wireless monitoring of vital signs). WARD24\/7 ApS has obtained license agreement for any WARD-project software and patents. One patent has been filed: \u201cWireless Assessment of Respiratory and circulatory Distress (WARD), EP 21184712.4 and EP 21205557.8\u201d.SR has no conflict of interest to declare.MS has no conflict of interest to declare.RS has no conflict of interest to declare.MV has no conflict of interest to declare.BV is a consultant for TEVA-ratiopharm (Ulm, Germany) and has received honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA), TEVA-ratiopharm and Vygon (Aachen, Germany).SZ has no conflict of interest to declare.AZ has no conflict of interest to declare.LK has no conflict of interest to declare.EV has no conflict of interest to declare.KK is a consultant for and has received honoraria for giving lectures from Edwards Lifesciences. KK is a consultant for Vygon (Aachen, Germany).BS is a consultant for Edwards Lifesciences (Irvine, CA, USA), Philips North America (Cambridge, MA, USA), GE Healthcare (Chicago, IL, USA), Vygon (Aachen, Germany), Masimo (Neuch\u00e2tel, Switzerland), Retia Medical (Valhalla, NY, USA), Maquet Critical Care (Solna, Sweden), Pulsion Medical Systems (Feldkirchen, Germany), Dynocardia (Cambridge, MA, USA), RDS (Strasbourg, France). BS has received institutional restricted research grants from Edwards Lifesciences, Baxter (Deerfield, IL, USA), GE Healthcare, Masimo, Philips Medizin Systeme B\u00f6blingen (B\u00f6blingen, Germany), CNSystems Medizintechnik (Graz, Austria), Pulsion Medical Systems, Vygon, Retia Medical, Osypka Medical (Berlin, Germany). BS has received honoraria for giving lectures from Edwards Lifesciences, Philips Medizin Systeme B\u00f6blingen, Baxter, GE Healthcare, Masimo, CNSystems Medizintechnik, Getinge (Gothenburg, Sweden), Pulsion Medical Systems, Vygon, Ratiopharm (Ulm, Germany). BS is an Editor of the British Journal of Anaesthesia.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"286"}}