Hemodynamic Instability, Orthopedic Disorder
Conditions
Brief summary
Blood pressure optimization has been considered as a crucial factor to avoid perioperative vital organ hypoperfusion, and perioperative hypotension has been addressed as a risk factor for complications and adverse clinical outcomes. Hypotension prediction index (HPI) is an novel machine-learning derived parameters, and was developed to predict the risk of future hypotension.Series of clinical studies have verified its clinical efficacy in avoiding perioperative hypotension. Major orthopedic surgeries, such as spine surgery, joint surgery, long bone fracture surgery, are quite common in elder people, who are vulnerable to perioperative adverse outcomes.Thus the investigator design this study to testify the clinical efficacy of implementing HPI in perioperative goal-directed hemodynamic therapy in elder patients receiving major orthopedic surgery.
Interventions
OTHERhypotension prediction index(HPI)
Implementing hypotension prediction index (HPI) in perioperative goal-directed hemodynamic therapy. Keep HPI \< 85; pulse pressure variation \>12%; keep cardiac index \>2L/min/cm\^2; keep mean arterial pressure \> 65mmHg.
OTHERordinary goal-directed hemodynamic therapy
Keep pulse pressure variation \>12%; keep cardiac index \>2L/min/cm\^2; keep mean arterial pressure \> 65mmHg.
Sponsors
National Taiwan University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* adults elder or equal to 60 years old receiving scheduled orthopedic surgery
Exclusion criteria
* Patients with a history of arrhythmia, congestive heart failure, preoperative neurocognitive disorder, cerebrovascular event, chronic obstructive pulmonary disease, chronic kidney disease, ongoing infectious disease, will be excluded.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Perioperative acute kidney injury | 24 hours | Acute kidney injury will be assessed according to the KDIGO guideline. Serum creatinine will be examined on the day before surgery and postoperative day 1. |
Other
| Measure | Time frame | Description |
|---|---|---|
| perioperative neurocognitive disorder | 30 day | Taiwan version of quick mild cognitive impairment(Qmci) test will be used to identify perioperative neurocognitive disorder |
Countries
Taiwan
Contacts
Primary ContactChen-Tse Lee, MD
Outcome results
None listed