Hemodynamic Monitoring and Resuscitation in Hip Fractures
- Conditions
- Fracture of Hip
- Registration Number
- NCT03401138
- Lead Sponsor
- Hvidovre University Hospital
- Brief Summary
Background: Fracture of the hip is a potentially fatal event in an elderly, frail, highly comorbid patient group suffering from dehydration and hypovolemia, and it carries a risk that equals major trauma in young patients in regard of physiological insult and severity, yet no preoperative resuscitation and transfusion strategy is available. An important goal of hemodynamic monitoring and resuscitation is early detection of insufficient tissue perfusion and oxygenation. The peripheral perfusion index reflects changes in peripheral perfusion and blood volume and a decreased peripheral perfusion index predicts surgical complications and morbidity in acute surgical and septic shock patients. The research group hypothesize that elderly frail patients with a fracture of the hip suffer from hypovolemia and peripheral hypoperfusion of varying degrees and accordingly respond to controlled fluid resuscitation and that the non-invasive peripheral perfusion index will serve as an early predictor of a deteriorated circulation in reflection of stroke volume.
Methods: The main objective of this prospective observational study is to assess to what extend patients with fracture of the hip suffer from hypovolemia and respond to a fluid challenge. The secondary objectives are to evaluate correlation between the minimally-invasive measurements of stroke volume and blood volume and the non-invasive measurement of peripheral perfusion index and near-infrared spectroscopy, as well as prevalence of postoperative complications and mortality. Fifty consecutive patients over the age of 65 years, presenting with a hip fracture, treated in a multimodal fast-track regimen, will be included when written informed consent is available. All patients will receive epidural analgesia and preoperative stroke volume-guided hemodynamic optimization. Blood volume measurements are performed and all patients are monitored with peripheral perfusion index and near-infrared spectroscopy.
Discussion: This is likely the first study to address clinically applicable hemodynamic monitoring and resuscitation in patients with fracture of the hip where adequate resuscitation is easily missed. The study group aim to evaluate the feasibility of preoperative stroke volume-guided hemodynamic optimization in the context of minimally- and non-invasive monitoring of peripheral perfusion and blood volume measurements.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 50
- Primary acute hip fracture
- Age grater than 65 years
- Written informed consent
- Contraindications to epidural analgesia
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Proportion of patients presenting with preoperative hypovolemia/reduced BV before and after epidural anesthesia Preoperatively Proportion of patients who respond to a 250 ml fluid challenge with sustained rise in SV by at least 10% Preoperatively Proportion of patients with low/very low PPI (PII<1.4 and < 0.5) before and after epidural anesthesia Preoperatively
- Secondary Outcome Measures
Name Time Method Correlation between non-invasive Hemoglobin (Hb), BV and arterial Hb Preoperatively Proportion of mortality in patients with high vs. low PPI and NIRS, including impact of BV At 30 days and 1 year Correlation between SV, PII and NIRS at normo- and hypovolemia states Preoperatively Proportion of mortality in patients responding to the fluid challenge vs. patients not responding At 30 days and 1 year Correlation between PPI and standard microcirculatory variables including lactate, capillary refill time (CRT), and central vs. peripheral temperature Preoperatively Proportion of postoperative complications in patients responding to the fluid challenge vs. patients not responding At 30 days and 1 year
Trial Locations
- Locations (1)
Department af Anesthesia, Hvidovre Hospital
🇩🇰Hvidovre, Copenhagen, Denmark