Femoral Fractures
Conditions
Keywords
oxygen delivery, proximal femoral fracture, goal-directed therapy
Brief summary
This is an observational pilot study of supernormal oxygen delivery goal for patients with proximal femoral fracture.
Detailed description
Augmentation of oxygen delivery using fluids with or without inotropes has been shown to improve surgical outcome in high-risk patients. Patients with proximal femoral fracture are considered high risk. However, most of this cohort elderly patients have poor cardiovascular condition and may not achieve the oxygen delivery goal. We will perform an observational pilot study whether the supernormal oxygen delivery is a valid hemodynamic goal for patients with proximal femoral fracture.
Interventions
PROCEDURESupernormal oxygen delivery goal therapy
A 10% increase in stroke volume (SV) after fluid challenge (5 ml/kg) with Ringer's lactate solution will be deemed positive. Oxygen delivery will be check when fluid challenge becomes negative. If oxygen delivery index (DO2I) can not be greater than 600 mL/m2, then dobutamine will be started at a dose of 2.5 μg/kg/min and increased by the same increment every 20 minutes until the described target is reached or until a maximal dose of 10 μg/kg/min is given. Dobutamine is decreased in dose or discontinued if the heart rate is above 100 beats per minute or shows signs of cardiac ischemia. Blood transfusions will be used to maintain a hemoglobin concentration over 8mg/dL.
Sponsors
Guangzhou First People's Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
70 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients aged over 70 yr * Weight over 35 kg * Underwent proximal femur fracture (PFF) surgery under peripheral nerve block and laryngeal mask airway anesthesia.
Exclusion criteria
* Patients who could be harmed due to the treatment (ongoing myocardial infarction, chronic dialysis) * Monoamine oxidase inhibitor use within the last 14 days * Pathological fractures and conditions * Inability to give informed consent(as judged by a research team member) * Anticipated difficulties obtaining data during the first postoperative year (as judged by a research team member)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Oxgen delivery index | At the end of 4 hour goal-directed therapy | To attain a improved oxygen delivery index at the end of 4 hour goal-directed therapy |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hear rate augmentation | Day 1 | — |
| Hemodynamic response | Day 1 | Including stroke volume, cardiac index, base excess, lactate, hemoglobin, and urine output. |
| fluid volume administrated | intraoperatively | — |
| Length of hospital stay | Day 30 | — |
| Postoperative morbidity | day 5 | — |
Countries
China
Contacts
Primary ContactXiangcai Ruan, MD, PhD
Backup ContactJingwen Guo
Outcome results
None listed