Fluid-responsiveness, blood volume and perfusion in preoperative haemodynamic optimisation of hip fracture patients; a prospective observational study

被引：2

作者：

Agerskov, Marianne ^{[1
]}

Sorensen, Henrik ^{[2
]}

Hojlund, Jakob ^{[1
]}

Secher, Niels H. ^{[2
]}

Foss, Nicolai Bang ^{[1
]}

机构：

[1] Univ Copenhagen, Hvidovre Hosp, Dept Anesthesiol & Intens Care, Copenhagen, Denmark

[2] Univ Copenhagen, Rigshosp, Ctr Canc & Organ Dis, Dept Anaesthesiol, Copenhagen, Denmark

来源：

ACTA ANAESTHESIOLOGICA SCANDINAVICA | 2022年 / 66卷 / 06期

关键词：

blood volume; haemodynamic optimisation; hip fracture; perfusion index; peripheral; preload responsiveness; RANDOMIZED CONTROLLED-TRIAL; PERIPHERAL PERFUSION; EPIDURAL-ANESTHESIA; HOSPITAL STAY; SURGERY; INDEX; REHABILITATION; MORBIDITY; INDICATOR;

D O I：

10.1111/aas.14070

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Background Preoperative resuscitation strategies in patients with hip fracture (HF) are lacking. We aimed to investigate fluid-responsiveness, peripheral perfusion index (PPI) and blood volume (BV)-status in patients with HF undergoing resuscitation in the preoperative phase. Methods In a prospective observational study, we evaluated preoperative fluid-responsiveness, indices of perfusion and BV before and after lumbar epidural analgesia in 50 patients with HF shortly after admittance. Results Initially, 18 (36%) patients were fluid-responsive (>= 10% increased SV in response to 250 ml fluid bolus) and 13 (26%) presented hypovolaemia (deviation of measured BV from estimated BV <= 0.9). According to fluid-responsiveness, no difference in absolute values of cardiac index (CI) (2.7 L [2.1-3.3] vs. 2.8 L [2.3-3.4], p = .5) was seen, but cardiac output (CO) rose significantly in the hypovolaemic patients: 9% [5-18] vs. 1% [-3-7], p = .004. After epidural analgesia, 26 (52%) patients were again fluid-responsive and 15 (30%) were hypovolaemic. CI was now significantly lower in fluid-responsive patients (2.2 L [1.7-2.7] vs. 2.9 L [2.3-3.5], p = .001). Prior to epidural analgesia, no significant trend towards hypovolaemic patients having lower indices of perfusion was seen. After epidural analgesia, more patients with hypovolaemia presented with PPI <= 1.5 (8 (53%) vs. 3 (9%), p = .001) and absolute values of PPI were also significantly lower if IBV was low (1.4 [0.9-3.2] vs. 3.2 [2.4-4.8], p = .01). PPI correlated with hypovolaemia after epidural analgesia (rho 0.4 [0.1-0.7], p = .007). Conclusions Preoperative fluid-responsivity in HF patients might be attributable to elements of hypovolaemia and sympathetic compensatory ability conjointly, confounding the use of SV-guided resuscitation. PPI could be associated with BV, which may support clinicians during perioperative haemodynamic optimisation.

引用

页码：660 / 673

页数：14

共 49 条

[1] Pre-operative haemodynamic monitoring and resuscitation in hip fracture patients: Protocol for a prospective observational study [J].

Agerskov, M. ;

Sorensen, H. ;

Hojlund, J. ;

Secher, N. H. ;

Foss, N. B. .

ACTA ANAESTHESIOLOGICA SCANDINAVICA, 2018, 62 (09) :1314-1320

[2] Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study [J].

Agerskov, Marianne ;

Thusholdt, Anna N. W. ;

Holm-Sorensen, Henrik ;

Wiberg, Sebastian ;

Meyhoff, Christian S. ;

Hojlund, Jakob ;

Secher, Niels H. ;

Foss, Nicolai B. .

BRITISH JOURNAL OF ANAESTHESIA, 2021, 127 (03) :396-404

[3] Protocol for a multicentre retrospective observational cohort study in Denmark: association between the intraoperative peripheral perfusion index and postoperative morbidity and mortality in acute non-cardiac surgical patients [J].

Agerskov, Marianne ;

Thusholdt, Anna Nicoline Wolfhagen ;

Hojlund, Jakob ;

Meyhoff, Christian Sahlholdt ;

Sorensen, Henrik ;

Wiberg, Sebastian ;

Secher, Niels Henry ;

Foss, Nicolai Bang .

BMJ OPEN, 2019, 9 (11)

[4] Randomized controlled trial of goal-directed haemodynamic treatment in patients with proximal femoral fracture [J].

Bartha, E. ;

Arfwedson, C. ;

Imnell, A. ;

Fernlund, M. E. ;

Andersson, L. E. ;

Kalman, S. .

BRITISH JOURNAL OF ANAESTHESIA, 2013, 110 (04) :545-553

[5] The effects of passive leg raising may be detected by the plethysmographic oxygen saturation signal in critically ill patients [J].

Beurton, Alexandra ;

Teboul, Jean-Louis ;

Gavelli, Francesco ;

Gonzalez, Filipe Andre ;

Girotto, Valentina ;

Galarza, Laura ;

Anguel, Nadia ;

Richard, Christian ;

Monnet, Xavier .

CRITICAL CARE, 2019, 23 (1)

[6] Acute cognitive dysfunction after hip fracture: frequency and risk factors in an optimized, multimodal, rehabilitation program [J].

Bitsch, MS ;

Foss, NB ;

Kristensen, BB ;

Kehlet, H .

ACTA ANAESTHESIOLOGICA SCANDINAVICA, 2006, 50 (04) :428-436

[7] Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial [J].

Borges, Flavia K. ;

Bhandari, Mohit ;

Guerra-Farfan, Ernesto ;

Patel, Ameen ;

Sigamani, Alben ;

Umer, Masood ;

Tiboni, Maria E. ;

del Mar Villar-Casares, Maria ;

Tandon, Vikas ;

Tomas-Hernandez, Jordi ;

Teixidor-Serra, Jordi ;

Avram, Victoria R. A. ;

Winemaker, Mitchell ;

Ramokgopa, Mmampapatla T. ;

Szczeklik, Wojciech ;

Landoni, Giovanni ;

Wang, Chew Yin ;

Begum, Dilshad ;

Neary, John D. ;

Adili, Anthony ;

Sancheti, Parag K. ;

Lawendy, Abdel-Rahman ;

Balaguer-Castro, Mariano ;

Sleczka, Pawel ;

Jenkinson, Richard J. ;

Nur, Aamer Nabi ;

Wood, Gavin C. A. ;

Feibel, Robert J. ;

McMahon, Stephen J. ;

Sigamani, Alen ;

Popova, Ekaterine ;

Biccard, Bruce M. ;

Moppett, Iain K. ;

Forget, Patrice ;

Landais, Paul ;

McGillion, Michael H. ;

Vincent, Jessica ;

Balasubramanian, Kumar ;

Harvey, Valerie ;

Garcia-Sanchez, Yaiza ;

Pettit, Shirley M. ;

Gauthier, Leslie P. ;

Guyatt, Gordon H. ;

Conen, David ;

Garg, Amit X. ;

Bangdiwala, Shrikant I. ;

Belley-Cote, Emilie P. ;

Marcucci, Maura ;

Lamy, Andre ;

Whitlock, Richard .

LANCET, 2020, 395 (10225) :698-708

[8] Transfusion thresholds for guiding red blood cell transfusion [J].

Carson, Jeffrey L. ;

Stanworth, Simon J. ;

Dennis, Jane A. ;

Trivella, Marialena ;

Roubinian, Nareg ;

Fergusson, Dean A. ;

Triulzi, Darrell ;

Doree, Carolyn ;

Hebert, Paul C. .

COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2021, (12)

[9] Cardiac output obtained by pulse pressure analysis: to calibrate or not to calibrate may not be the only question when used properly [J].

Cecconi, Maurizio ;

Malbrain, Manu L. N. G. .

INTENSIVE CARE MEDICINE, 2013, 39 (04) :787-789

[10] Cerebral oximetry during preoperative resuscitation in elderly patients with hip fracture: a prospective observational study [J].

Clemmesen, C. G. ;

Pedersen, L. M. ;

Hougaard, S. ;

Andersson, M. L. ;

Rosenkvist, V. ;

Nielsen, H. B. ;

Palm, H. ;

Foss, N. B. .

JOURNAL OF CLINICAL MONITORING AND COMPUTING, 2018, 32 (06) :1033-1040

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