Haemodynamic Instability Clinical Trial
Official title:
Non-invasive Stroke Volume-based fluid Management in Elderly Patients Undergoing Hip Fracture Surgery Under Spinal Anaesthesia
The study is going to be a single-centre prospective randomized trial. Patients will be randomly allocated to either control group (anesthetist-directed fluid therapy) or goal directed fluid therapy group, in which fluid therapy was guided by stoke volume (SV) algorithm with the use of Nexfin monitor. Primary outcome measures were the time to hospital discharge since surgery and the occurence of complications developed during the postoperative period. Secondary outcomes included the incidence of intraoperative hypotensive episodes (with MAP<65mmHg) in both groups and the requirement of vasoactive drugs to support blood pressure
The study is going to be a single-centre prospective randomized trial in elderly patients
undergoing hip fracture surgery under spinal anesthesia.
Patients will be randomly allocated to either control group (anesthetist-directed fluid
therapy) or goal directed fluid therapy group, in which fluid therapy was guided by stoke
volume (SV) algorithm with the use of Nexfin monitor.
In patients of the control group management of the hemodynamic status will be performed in
the discretion of the attending anesthesiologist, with the aim of keeping mean arterial
pressure (MAP) > 65mmHg. The type and amount of delivered fluids, and vasoactive or inotropic
drugs will be recorded.
In Goal Directed Fluid Therapy group, fluid management will be guided by the Nexfin monitor,
based on stroke volume of the patient under continuous tracking. Baseline SV will be measured
after the patients will be turned to left/right position (at which they are going to stay
throughout the whole procedure) and before the implementation of regional anesthesia. Fluid
challenges of 250 ml will be repeated until the SV fails to increase by 10%. At this point,
preload is considered optimized and SV optimum iss defined. SV trigger is defined as SV opt -
10%. After obtaining these values, the anesthetic and surgical interventions could proceed.
During surgery, N/S 250ml boluses will be administered when SV is below SV trigger. Inotropic
drugs will be administered (dobutamine infusion at 0.2-10mcg/kg/min) if CO is below 3.5 L/min
and vasopressors (phenylephrine bolus doses of 50-100mcg) if SV and CO are within the target
range but MAP is below 65mmHg.
Primary outcome measures were the time to hospital discharge since surgery and the occurence
of complications developed during the postoperative period. Secondary outcomes included the
incidence of intraoperative hypotensive episodes (with MAP<65mmHg) in both groups and the
requirement of vasoactive drugs to support blood pressure
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