TY - JOUR

T1 - Fluid-responsiveness, blood volume and perfusion in preoperative haemodynamic optimisation of hip fracture patients; a prospective observational study

AU - Agerskov, Marianne

AU - Sørensen, Henrik

AU - Højlund, Jakob

AU - Secher, Niels H

AU - Foss, Nicolai Bang

N1 - Publisher Copyright: © 2022 Acta Anaesthesiologica Scandinavica Foundation.

PY - 2022

Y1 - 2022

N2 - 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.

AB - 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.

KW - Blood volume

KW - Haemodynamic optimisation

KW - Hip fracture

KW - Perfusion index

KW - Peripheral

KW - Preload responsiveness

U2 - 10.1111/aas.14070

DO - 10.1111/aas.14070

M3 - Journal article

C2 - 35396854

AN - SCOPUS:85128310821

VL - 66

SP - 660

EP - 673

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

IS - 6

ER -