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Crude incidence rate in Spain of hip fracture in people over 65 years was 511 cases per 100,000 in 2002. About 30% of patients die in the first year. Cardiocirculatory complications during and after surgery partly explain this high morbidity and mortality. Most patients are frail and with multicomorbidity. Goal-Directed Hemodynamic Therapy (GDT) based on noninvasive continuous monitoring of blood pressure, heart rate, oxygen saturation, cardiac output, cardiac index, stroke volume and stroke volume index can reduce perioperative complications and improve survival. The objective of our study is to assess the efficacy of a goal-directed hemodynamic therapy in reducing perioperative complications. Patients and Methods: non-randomized intervention study with a historical control and 1-year follow-up. Patients older than 64 years with non-traumatic hip fracture requiring surgical intervention. In the control group standard care was performed based on non-invasive, intermittent arterial pressure measurement, obtained every 5 minutes, continuous heart rate, and oxygen saturation. In the intervention group GDT based on noninvasive monitoring will be performed. The main outcome will be the percentage of patients with perioperative complications. Secondary outcomes: LOS and survival at 12 months of surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control group | No Intervention | Hemodynamic optimization according to the standards of perioperative monitoring of our center. In the intraoperative period hemodynamic monitoring will be done by management of blood pressure, heart rate and oxygen saturation | |
| GDT noninvasive monitoring group | Experimental | GDT based on noninvasive monitoring System ClearSight® and Platform EV Clinic 1000® |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| GDT based on noninvasive monitoring | Other | Before entering the operating room, hemodynamic optimization start by optimizing preload with Fluid Challenge according to evidence-based GDT protocols. Once stabilized the cardiovascular system after induction of anesthesia, hemodynamic optimization continue with Mini Fluid Challenge. In the intraoperative period, hemodynamic optimization is based on maintaining systolic blood pressure and stroke volume. A Mini Fluid Challenge is administered to patients who respond to volume or a vasoactive drug according cardiac index for non-responders. |
| Measure | Description | Time Frame |
|---|---|---|
| Percentage of patients who developed intraoperative haemodynamic instability | Intraoperative haemodynamic instability, defined as one measurement of SAP < 90 mmHg in the CG and for at least one minute in the IG and/or the need for a bolus of vasoconstrictor. | Intraoperative period |
| Measure | Description | Time Frame |
|---|---|---|
| Intraoperative arrhythmias | Electrocardiographic evidence of cardiac rhythm disturbance. | Intraoperative period |
| Postoperative complications | Major cardiovascular complications, minor cardiovascular complications, Respiratory, Renal, Infections, Surgical reintervention during hospital stay |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Joan Bosch Sabater, MD PhD | Althaia Xarxa Assistencial Universitària de Manresa | Study Chair |
| Francesca Reguant Corominas, MD PhD | Althaia Xarxa Assistencial Universitària de Manresa | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Althaia Xarxa Assistencial Universitària de Manresa | Manresa | Barcelona | 08243 | Spain |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35945605 | Derived | Lorente JV, Reguant F, Arnau A, Borderas M, Prieto JC, Torrallardona J, Carrasco L, Solano P, Perez I, Farre C, Jimenez I, Ripolles-Melchor J, Monge MI, Bosch J. Effect of goal-directed haemodynamic therapy guided by non-invasive monitoring on perioperative complications in elderly hip fracture patients within an enhanced recovery pathway. Perioper Med (Lond). 2022 Aug 10;11(1):46. doi: 10.1186/s13741-022-00277-w. |
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| ID | Term |
|---|---|
| D006620 | Hip Fractures |
| ID | Term |
|---|---|
| D005264 | Femoral Fractures |
| D050723 | Fractures, Bone |
| D014947 | Wounds and Injuries |
| D025981 | Hip Injuries |
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|
|
| System ClearSight® and Platform EV Clinic 1000® | Device | Hemodynamic control is held by non-invasive continuous monitoring techniques (system ClearSight® and Platform EV Clinic 1000®). Monitored variables: blood pressure, heart rate, oxygen saturation, cardiac output, cardiac index, stroke volume and stroke volume index. |
|
| Postoperative period |
| Hospital stay | Length of hospital stay (days) | Patients will be followed for the duration of hospital stay, an expected median of 11 days |
| Survival | One-year survival |
| D007869 |
| Leg Injuries |