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Intervention Review

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Perioperative fluid volume optimization following proximal femoral fracture

  1. James D Price1,*,
  2. John JW Sear2,
  3. Richard RM Venn3

Editorial Group: Cochrane Anaesthesia Group

Published Online: 26 JAN 2004

Assessed as up-to-date: 9 NOV 2003

DOI: 10.1002/14651858.CD003004.pub2


How to Cite

Price JD, Sear JJW, Venn RRM. Perioperative fluid volume optimization following proximal femoral fracture. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD003004. DOI: 10.1002/14651858.CD003004.pub2.

Author Information

  1. 1

    Oxford Radcliffe Hospitals NHS Trust, Kadoorie Centre for Critical Care Research and Education, Oxford, Oxon, UK

  2. 2

    University of Oxford, Nuffield Department of Anaesthetics, Oxford, UK

  3. 3

    Worthing Hospital, Worthing, UK, Department of Anaesthesia and Intensive Care, Worthing, UK

*James D Price, Kadoorie Centre for Critical Care Research and Education, Oxford Radcliffe Hospitals NHS Trust, John Radcliffe Hospital, Headley Way, Oxford, Oxon, OX3 9DU, UK. james.price@geratol.ox.ac.uk .

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 26 JAN 2004

SEARCH

This is not the most recent version of the article. View current version (11 SEP 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Proximal Femoral Fracture (PFF) or 'hip fracture' is a frequent injury, and adverse outcomes are common. Several factors suggest the importance of developing techniques to optimize intravascular fluid volume. These may include protocols that enhance the efficacy of clinicians' assessments, invasive techniques such as oesophageal Doppler or central venous pressure monitoring, or advanced non-invasive techniques such as plethysmographic pulse volume determination.

Objectives

To determine the optimal method of fluid volume optimization for adult patients undergoing surgical repair of PFF. Comparisons of fluid types, of blood transfusion strategies or of pharmacological interventions are not considered in this review.

Search methods

We searched CENTRAL (The Cochrane Library, issue 4, 2003), MEDLINE (1985 to 2003), EMBASE (1985 to 2003), and bibliographies of retrieved articles. Relevant journals and conference proceedings were handsearched.

Selection criteria

Randomized controlled studies comparing a fluid optimization intervention with normal practice or with another fluid optimization intervention, in patients following PFF undergoing surgery of any type under anaesthesia of any type.

Data collection and analysis

Searches and exclusion of clearly irrelevant articles were performed by one reviewer. Two reviewers examined independently the remaining studies, extracting study quality and results data. A wide range of short- and long-term outcome data were sought. Studies were excluded if they did not meet selection criteria or if results were likely to be biased. Due to inconsistent data reporting, combination of data was not generally possible.

Main results

Searches identified four trials, of which two studies, randomizing a total of 130 patients, were of adequate quality and addressed the review question. Both studies were of invasive advanced haemodynamic monitoring, either oesophageal Doppler ultrasonography or central venous pressure monitoring, during the intraoperative period only. In both, invasive monitoring led to significant increases in fluid volumes infused and reductions in length of hospital stay. The pooled Peto odds ratio for in-hospital fatality was 1.44 (95% confidence interval 0.45-4.62). Neither study followed patients beyond hospital discharge or assessed functional outcomes. No serious complications were directly attributable to the interventions. There were no studies of protocol-guided fluid optimization or of advanced non-invasive techniques.

Authors' conclusions

Invasive methods of fluid optimization during surgery may shorten hospital stay, but their effects on other important, patient-centred, longer-term outcomes are uncertain. Adverse effects on fatality cannot be excluded. Other fluid optimization techniques have not been evaluated. The lack of randomized studies of adequate quality addressing this important question is disappointing. More research is needed.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Techniques, for detecting when patients undergoing surgery for hip fracture need more fluid, may reduce hospital stay, but more research is needed.

Hip fracture is common, and the outcome may be poor. Many patients need more fluid, but clinicians find it difficult to tell how much is needed. Protocols (formal guidance) or advanced monitoring techniques (such as central venous pressure monitoring) may help guide fluid therapy. This review of trials found no evidence about the value of protocols. Some small trials suggest that advanced monitoring techniques shorten the duration of hospital care and have few adverse effects, but more research is needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

近端股骨骨折術中體液容積最佳化

近端股骨骨折或髖骨骨折是常發生的傷害,而且常有不好的預後。有一些因素指出了發展維持理想血管內體液容積的技術的重要性。這可能包括了以下的治療計畫:提升臨床醫師的評估能力、侵入性的技術如經食道超音波(oesophageal Doppler)或中央靜脈壓(central venous pressure)監測、或者是進階的非侵入性的技術如血管容積變化信號的測定(plethysmographic pulse volume determination)。

目標

對於接受近端股骨骨折復位手術的成年人,制訂出維持理想血管內體液容積的理想方法。比較不同種輸液、輸血的策略、或藥物介入性治療等,不在這篇文章的考慮之內。

搜尋策略

我們搜尋了CENTRAL (The Cochrane Library, issue 4, 2003), MEDLINE (1985 to 2003), EMBASE (1985 to 2003),以及這些文章的參考文獻。相關的期刊和會議記錄為手動搜尋。

選擇標準

這些隨機的對照研究,是近端股骨骨折的病人,無論是接受哪一種手術或哪一種麻醉,比較兩種維持理想體液的方法、或與平常習慣的作法比較。

資料收集與分析

搜尋及排除明顯不相關文章的工作由一位檢閱者執行。另外兩位檢閱者各自獨立地審查被保留下來的文章,確保研究的品質與結果。大範圍的短期與長期結果的資料都被找出。未符合選擇標準、或結論可能有偏差的研究皆被排除。因為發表的資料缺乏一致性,所以合併資料通常是不可能的。

主要結論

搜尋的結果確認了四種試驗,其中兩種研究隨機挑選了一百三十位病人,符合足夠的品質而且回覆了檢閱者的問題。兩個研究在手術期間,皆有侵入性的進階血行動力學監測:經食道超音波、或中央靜脈壓監測。兩者的結果皆顯示,侵入性的監測使得輸液量有顯著的增加,以及住院時間縮短。院內死亡的pooled Peto odds ratio為1.44 (95% confidence interval 0.45−4.62)。沒有任何一個研究追蹤出院後的病人或是評估功能上的預後。沒有任何嚴重的併發症是直接與介入性的治療有關。沒有研究是使用治療計畫為指引或是使用進階的非侵入性技術。

作者結論

手術中使用侵入性的方法來維持理想體液可以縮短住院時間,但是對於其他重要的、以病人為中心的、長期的預後則是不確定的。併發症造成的死亡不可能完全避免。還有一些其他的技術尚未被評估。令人失望的是,針對這個重要的問題,目前還缺乏有足夠品質的隨機研究。我們還需要更多的研究。

翻譯人

本摘要由臺灣大學附設醫院劉婉琪翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

髖骨骨折的病人接受手術時,這些能夠發現病人何時需要更多輸液的技術,可以縮短住院時間,但是我們還需要更多的研究。髖骨骨折是很常見的,而且預後有可能很差。許多病人需要更多的輸液,但臨床醫師很難判斷到底需要多少。使用治療計畫或進階的監測技術如中央靜脈壓監測,可能可以幫助指引輸液的治療。這篇文章沒有找到有價值的治療計畫的證據。一些小型的試驗指出,進階的監測技術縮短了需要住院照護的時間,以及較少的併發症,但還是需要更多的證據支持。