Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial.

摘要: Abstract Objectives: To assess whether intraoperative intravascular volume optimisation improves outcome and shortens hospital stay after repair of proximal femoral fracture. Design: Prospective, randomised controlled trial comparing conventional fluid management with repeated colloid challenges monitored by oesophageal Doppler ultrasonography to maintain maximal stroke throughout the operative period. Setting: Teaching hospital, London. Subjects: 40 patients undergoing fracture under general anaesthesia. Interventions: Patients were randomly assigned receive either (control patients) or additional used period (protocol patients). Main measures: Time declared medically fit for discharge, duration (in acute bed; in plus long bed), mortality, perioperative haemodynamic changes. Results: Intraoperative loading produced significantly greater changes (median 15 ml (95% confidence interval 10 21 ml)) cardiac output (1.2 l/min (0.1 2.3 l/min)) than conventionally managed group (−5 (−10 1 ml) −0.4 (−1.0 0.2 (P Conclusions: Proximal constitutes surgery a high risk population. optimal resulted more rapid postoperative recovery reduced stay. Key messages hip constitute considerable mortality morbidity an often protracted These have depleted rarely invasive monitoring dependency care Haemodynamic guided pulmonary artery catheter has been shown improve major surgery, but this is not considered routinely practicable Intravascular directed minimally reduces