Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Dissertation committee:
Σιδηροπούλου Τατιανή, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπουσα
Σαββίδου Όλγα, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Σαραντέας Θεοδόσιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Πικουλής Εμμανουήλ, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Νάστος Κωνσταντίνος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δελλαπόρτας Διονύσιος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μπριασούλης Παναγιώτης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Διεγχειρητική στοχευμένη χορήγηση υγρών, με χρήση μη επεμβατικού monitoring της καρδιακής παροχής (Nexfin HD monitor): Επίδραση στην έκβαση ηλικιωμένων ασθενών που υποβάλλονται σε χειρουργεία αποκατάστασης καταγμάτων ισχίου, υπό περιοχική αναισθησία
Translated title:
Intraoperative goal directed fluid therapy using non invasive cardiac output monitoring : Impact on the overall prognosis of elderly patients undergoing hip fracture surgery under regional anaesthesia
Summary:
Background: Hip fractures in elderly are associated with increased morbidity and mortality. One aspect of intraoperative management that could be beneficial in reducing postoperative complications is goal-directed fluid therapy (GDFT)
Objectives: We aimed to investigate whether intraoperative GDFT, during hip fracture repair under regional anesthesia, based on optimization of Stroke Volume (SV) could favor these patients.
Methods: A single-centre, prospective, trial was conducted among 60 patients, who underwent hip fracture surgery under spinal anesthesia. Patients were randomly allocated to either GDFT group (fluid treatment was based on continuous monitoring and optimization of SV) or control group (routine fluid treatment was established). Primary outcome measures were the time to hospital discharge since surgery and the occurrence of postoperative complications. Secondary outcomes included the incidence of intraoperative hypotensive episodes (MAP<65mmHg) and the requirement of vasoactive drugs to support blood pressure. Quantitative variables were expressed as mean (Standard Deviation) or as median (interquartile range). Qualitative variables were expressed as absolute and relative frequencies. For the comparison of proportions chi-square and Fisher’s exact tests were used. Students’t-tests or Mann-Whitney tests were used for the comparison of continuous variables between two groups.
Results: The duration of hospitalization was significantly smaller in GDFT group (p-value <0.001). Most of the postoperative complications recorded, did not differ between the two groups of patients, except acute kidney injury, which was significantly lower in the GDFT group (P-value =0.006). In addition, patients in GDFT group had a significantly lower need for intraoperative administration of vasoactive drugs and the degree of decrease of MAP throughout surgery was also significantly lower in these patients.
Conclusions: GDFT during hip fracture repair in elderly patients under spinal anesthesia, guided by a completely non-invasive method, reduces the length of hospital stay and the risk of postoperative acute kidney injury. It also reduces the use of vasoactive medications to support intraoperative hemodynamics.
Main subject category:
Health Sciences
Keywords:
Goal directed fluid therapy, Non invasive hemodynamic monitoring, Regional anaesthesia, Hip fractures
Number of references:
214
