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Doppler-Abstract-Relevant-Controlled-Trials5

Randomized Controlled Trial

Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures

R. Venn1, A. Steele2, P. Richardson3, J. Poloniecki4, M. Grounds5 and P. Newman5

1Department of Anaesthesia and Intensive Care, Worthing Hospital, Lyndhurst Road, Worthing, W. Sussex BN11 2DH, UK. 2Department of Intensive Care, Hammersmith Hospital, Du Cane Rd, London W12 0HS, UK. 3St Andrews Centre, Broomfield Hospital, Court Rd, Chelmsford CM1 7EY, UK. 4St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK. 5Department of Intensive Care, St James Wing, St George's Hospital, Blackshaw Road, London SW17 0QT, UK*Corresponding author

These findings were presented in part at the 13th Annual Meeting of the European Society of Intensive Care Medicine, Rome 2000.

Background. A prospective, randomized controlled trial comparing conventional intraoperative fluid management with two differing methods of invasive haemodynamic monitoring to optimize intraoperative fluid therapy, in patients undergoing proximal femoral fracture repair under general anaesthesia.

Methods. Ninety patients randomized to three groups; conventional intraoperative fluid management (Gp CON, n=29), and two groups receiving additional repeated colloid fluid challenges guided by central venous pressure (Gp CVP, n=31) or oesophageal Doppler ultrasonography (Gp DOP, n=30). Primary outcome measures were time to medical fitness to discharge, hospital stay and postoperative morbidity.

Results. The fluid challenge resulted in significantly greater perioperative changes in central venous pressure between Gp CVP and Gp CON (mean 5 (95% confidence interval 3-7) mm Hg) (P<0.0001). Important perioperative changes were also shown in Gp DOP with increases of 49.4 ms (19.7-79.1 ms) in the corrected flow time, 13.5 ml (7.4-19.6 ml) in stroke volume, and 0.9 (0.49-1.39) litre min-1 in cardiac output. As a result, fewer patients in Gp CVP and Gp DOP experienced severe intraoperative hypotension (Gp CON 28% (8/29), Gp CVP 9% (3/31), Gp DOP 7% (2/30), P=0.048 (chi-squared, 2 degrees of freedom (df)). No differences were seen between the three groups when major morbidity and mortality were combined, P=0.24 (chi-squared, 2 df). Postoperative recovery for survivors, as defined by time to be deemed medically fit for discharge, was significantly faster, in comparison with Gp CON, in both the Gp CVP (10 vs 14 (95% confidence interval 8-12 vs 12-17) days, P=0.008 (t-test)), and Gp DOP (8 vs 14 (95% confidence interval 6-12 vs 12-17) days, P=0.023 (t-test). There were no significant differences between groups, for survivors, with respect to acute orthopaedic hospital and total hospital stay.

Conclusions. Invasive intraoperative haemodynamic monitoring with fluid challenges during repair of femoral fracture under general anaesthetic shortens time to being medically fit for discharge.

Br J Anaesth 2002; 88: 65-71