Randomized controlled trial of goal-directed haemodynamic treatment in patients with proximal femoral fracture

被引:60
作者
Bartha, E. [1 ]
Arfwedson, C. [1 ]
Imnell, A. [1 ]
Fernlund, M. E. [1 ]
Andersson, L. E. [1 ]
Kalman, S. [1 ]
机构
[1] Karolinska Inst, CLINTEC, Div Anaesthesiol, Karolinska Univ Hosp, Stockholm, Sweden
关键词
complications; elderly; fluid therapy; haemodynamics; hip fractures; RISK SURGICAL-PATIENTS; HIP FRACTURE; HOSPITAL STAY; OXYGEN DELIVERY; OPTIMIZATION; METAANALYSIS; SURGERY; COMPLICATIONS; DOBUTAMINE; MORTALITY;
D O I
10.1093/bja/aes468
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background. Patients with proximal femoral fracture (PFF) are at high risk of postoperative complications. Goal-directed haemodynamic treatment (GDHT) in other high-risk surgical patients reduces postoperative complications. We aimed to compare effects of GDHT and routine fluid treatment (RFT) on postoperative outcomes after PFF surgery. Methods. PFF patients (>= 70 yr) were enrolled in this single-centre, open, randomized, controlled, parallel-group superiority trial with concealed allocation using computer-generated randomization. Treatments: (i) GDHT to attain oxygen delivery index >600 ml min(-1) m(-2) using fluids and dobutamine and (ii) a protocol-guided RFT. After 150 enrolled patients, the trial was stopped due to slow recruitment. The short-term primary outcome measure was the relative risk (RR) of postoperative complications; secondary measures were (i) administered fluid levels, (ii) vasopressor requirements, and (iii) haemodynamic responses. Results. For the GDHT group, 74 and for the RFT group 75 patients were designated. The RR of postoperative complications (GDHT vs RFT) was 0.79 (95% confidence interval 0.54-1.16); the volumes of i. v. fluids decreased (1078 vs 1440 ml, P = 0.01); fewer patients required treatment of hypotension (18.5% vs 75%, P < 0.005); there were more patients with increased oxygen delivery at the end of operation (28% vs 8%, P = 0.04), but the haemodynamic goal was achieved in only 27% of patients in the GDHT group. Conclusions. The magnitude of risk reduction of postoperative complications is clinically relevant, but the trial was underpowered and the null hypothesis cannot be rejected.
引用
收藏
页码:545 / 553
页数:9
相关论文
共 26 条
[1]  
[Anonymous], 2004, GUID METH TECHN APPR
[2]  
[Anonymous], COCHRANE DATABASE SY, DOI DOI 10.1002/14651858.CD003004.PUB2
[3]   Cost-effectiveness Analysis of Goal-directed Hemodynamic Treatment of Elderly Hip Fracture Patients Before Clinical Research Starts [J].
Bartha, Erzsebet ;
Davidson, Thomas ;
Hommel, Ami ;
Thorngren, Karl-Goran ;
Carlsson, Per ;
Kalman, Sigridur .
ANESTHESIOLOGY, 2012, 117 (03) :519-530
[4]   Costs and quality of life associated with osteoporosis-related fractures in Sweden [J].
Borgström, F ;
Zethraeus, N ;
Johnell, O ;
Lidgren, L ;
Ponzer, S ;
Svensson, O ;
Abdon, P ;
Ornstein, E ;
Lunsjö, K ;
Thorngren, KG ;
Sernbo, I ;
Rehnberg, C ;
Jönsson, B .
OSTEOPOROSIS INTERNATIONAL, 2006, 17 (05) :637-650
[5]   The oxygen trail: the goal [J].
Boyd, O ;
Hayes, M .
BRITISH MEDICAL BULLETIN, 1999, 55 (01) :125-139
[6]   Achieving the goal [J].
Boyd, O ;
Bennett, ED .
CRITICAL CARE MEDICINE, 1999, 27 (10) :2298-2299
[7]  
Boyd O, 2003, CURR ANAESTH CRIT CA, V13, P206
[8]   Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens - A randomized assessor-blinded multicenter trial [J].
Brandstrup, B ;
Tonnesen, H ;
Beier-Holgersen, R ;
Hjortso, E ;
Ording, H ;
Lindorff-Larsen, K ;
Rasmussen, MS ;
Lanng, C ;
Wallin, L ;
Iversen, LH ;
Gramkow, CS ;
Okholm, M ;
Blemmer, T ;
Svendsen, PE ;
Rottensten, HH ;
Thage, B ;
Riis, J ;
Jeppesen, IS ;
Teilum, D ;
Christensen, AM ;
Graungaard, B ;
Pott, F .
ANNALS OF SURGERY, 2003, 238 (05) :641-648
[9]  
Briggs ACKSM., 2007, Decision Modelling for Health Economic Evaluation
[10]  
Copeland G P, 1991, Br J Surg, V78, P355, DOI 10.1002/bjs.1800780327