Hemodynamic Monitoring and Resuscitation in Hip Fractures

NCT ID: NCT03401138

Last Updated: 2019-10-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

50 participants

Study Classification

OBSERVATIONAL

Study Start Date

2018-02-14

Study Completion Date

2019-10-28

Brief Summary

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Background: Fracture of the hip is a potentially fatal event in an elderly, frail, highly comorbid patient group suffering from dehydration and hypovolemia, and it carries a risk that equals major trauma in young patients in regard of physiological insult and severity, yet no preoperative resuscitation and transfusion strategy is available. An important goal of hemodynamic monitoring and resuscitation is early detection of insufficient tissue perfusion and oxygenation. The peripheral perfusion index reflects changes in peripheral perfusion and blood volume and a decreased peripheral perfusion index predicts surgical complications and morbidity in acute surgical and septic shock patients. The research group hypothesize that elderly frail patients with a fracture of the hip suffer from hypovolemia and peripheral hypoperfusion of varying degrees and accordingly respond to controlled fluid resuscitation and that the non-invasive peripheral perfusion index will serve as an early predictor of a deteriorated circulation in reflection of stroke volume.

Methods: The main objective of this prospective observational study is to assess to what extend patients with fracture of the hip suffer from hypovolemia and respond to a fluid challenge. The secondary objectives are to evaluate correlation between the minimally-invasive measurements of stroke volume and blood volume and the non-invasive measurement of peripheral perfusion index and near-infrared spectroscopy, as well as prevalence of postoperative complications and mortality. Fifty consecutive patients over the age of 65 years, presenting with a hip fracture, treated in a multimodal fast-track regimen, will be included when written informed consent is available. All patients will receive epidural analgesia and preoperative stroke volume-guided hemodynamic optimization. Blood volume measurements are performed and all patients are monitored with peripheral perfusion index and near-infrared spectroscopy.

Discussion: This is likely the first study to address clinically applicable hemodynamic monitoring and resuscitation in patients with fracture of the hip where adequate resuscitation is easily missed. The study group aim to evaluate the feasibility of preoperative stroke volume-guided hemodynamic optimization in the context of minimally- and non-invasive monitoring of peripheral perfusion and blood volume measurements.

Detailed Description

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Conditions

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Fracture of Hip

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Interventions

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Preoperative Stroke Volume(SV)-guided fluid optimization

Preoperative SV-guided hemodynamic optimization will be commenced with patients receiving 250ml fluid challenges over five minutes aiming to maximize SV. Maximal SV is defined as absence of a sustained rise in SV by at least 10% in response to a fluid challenge.

PPI will be obtained from the Masimo Radical 7 (Masimo, Irvine, CA, USA) and NIRS from Invos 5100C (Medtronic, Minneapolis, MN, USA).

BV measurements will use pulse dye densitometry (PDD) with Indocyanine Green (ICG). We will use the Dye Densitogram 3300 analyser Nihon Kohden (Tokyo, Japan) for registration of the spectrophotometrical absorption of ICG and calculation of BV.

Intervention Type OTHER

Other Intervention Names

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Blood volume measurement Monitoring of Peripheral Perfusion Index (PPI) Monitoring of Near-infrared Spectroscopy (NIRS)

Eligibility Criteria

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Inclusion Criteria

* Primary acute hip fracture
* Age grater than 65 years
* Written informed consent

Exclusion Criteria

\- Contraindications to epidural analgesia
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hvidovre University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Marianne Agerskov

MD, Reseach Fellow

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nicolai Bang Foss, Clinical Professor

Role: STUDY_DIRECTOR

Department of Anesthesia, Hvidovre Hospital

Jakob Højlund, MD, Senior Hospital Physiscian

Role: STUDY_CHAIR

Department of Anesthesia, Hvidovre Hospital

Henrik Sørensen, MD, DMSc

Role: STUDY_CHAIR

Abdominal Centre, Department of Anesthesia, Rigshospitalet

Niels Secher, Professor, DMSc

Role: STUDY_CHAIR

Abdominal Centre, Department of Anesthesia, Rigshospitalet

Marianne Agerskov, MD, Research Fellow

Role: PRINCIPAL_INVESTIGATOR

Department of Anesthesia, Hvidovre Hospital

Locations

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Department af Anesthesia, Hvidovre Hospital

Hvidovre, Copenhagen, Denmark

Site Status

Countries

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Denmark

References

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Agerskov M, Sorensen H, Hojlund J, Secher NH, Foss NB. Pre-operative haemodynamic monitoring and resuscitation in hip fracture patients: Protocol for a prospective observational study. Acta Anaesthesiol Scand. 2018 Oct;62(9):1314-1320. doi: 10.1111/aas.13163. Epub 2018 May 30.

Reference Type DERIVED
PMID: 29851062 (View on PubMed)

Other Identifiers

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H- 17037633

Identifier Type: -

Identifier Source: org_study_id

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