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Observational Study
. 2023 Apr 6;18(1):281.
doi: 10.1186/s13018-023-03738-0.

Goal-directed fluid therapy using uncalibrated pulse contour analysis and balanced crystalloid solutions during hip revision arthroplasty: a quality implementation project

R F Trauzeddel  1 , M Leitner  1 , L Dehé  1 , M Nordine  1 , S K Piper  2   3 , M Habicher  4 , M Sander  4 , C Perka  5 , S Treskatsch  6
Affiliations
Observational Study

Goal-directed fluid therapy using uncalibrated pulse contour analysis and balanced crystalloid solutions during hip revision arthroplasty: a quality implementation project

R F Trauzeddel et al. J Orthop Surg Res. .

Abstract

Background: To implement a goal-directed fluid therapy (GDFT) protocol using crystalloids in hip revision arthroplasty surgery within a quality management project at a tertiary hospital using a monocentric, prospective observational study.

Methods: Adult patients scheduled for elective hip revision arthroplasty surgery were screened for inclusion in this prospective study. Intraoperatively stroke volume (SV) was optimized within a previously published protocol using uncalibrated pulse contour analysis and balanced crystalloids. Quality of perioperative GDFT was assessed by protocol adherence, SV increase as well as the rate of perioperative complications. Findings were then compared to two different historical groups of a former trial: one receiving GDFT with colloids (prospective colloid group) and one standard fluid therapy (retrospective control group) throughout surgery. Statistical analysis constitutes exploratory data analyses and results are expressed as median with 25th and 75th percentiles, absolute and relative frequencies, and complication rates are further given with 95% confidence intervals for proportions using the normal approximation without continuity correction.

Results: Sixty-six patients underwent GDFT using balanced crystalloids and were compared to 130 patients with GDFT using balanced colloids and 130 controls without GDFT fluid resuscitation. There was a comparable increase in SV (crystalloids: 65 (54-74 ml; colloids: 67.5 (60-75.25 ml) and total volume infused (crystalloids: 2575 (2000-4210) ml; colloids: 2435 (1760-3480) ml; and controls: 2210 (1658-3000) ml). Overall perioperative complications rates were similar (42.4% (95%CI 30.3-55.2%) for crystalloids and 49.2% (95%CI 40.4-58.1%) for colloids and lower compared to controls: 66.9% (95%CI 58.1-74.9)). Interestingly, a reduced number of hemorrhagic complications was observed within crystalloids: 30% (95%CI 19.6-42.9); colloids: 43% (95%CI 34.4-52.0); and controls: 62% (95%CI 52.6-69.9). There were no differences in the rate of admission to the post-anesthesia care unit or intensive care unit as well as the length of stay.

Conclusions: Perioperative fluid management using a GDFT protocol with crystalloids in hip revision arthroplasty surgery was successfully implemented in daily clinical routine. Perioperative complications rates were reduced compared to a previous management without GDFT and comparable when using colloids.

Trial registration: ClinicalTrials.gov identifier: NCT01753050.

Keywords: Balanced colloid solutions; Balanced crystalloid solutions; Goal-directed fluid therapy; Hip revision arthroplasty; Perioperative; Uncalibrated pulse contour analysis.

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Conflict of interest statement

RFT, ML, LD, MN, SKP and CP have nothing to declare. MH received payment from Edwards Lifesciences and AMOMED due to lecturing activities. MS received financial activities from Edwards Lifesciences, Medtronic, the Getinge Group, FERRER, AMOMED, Orion Pharma, Grünenthal, Fisher & Paykel, BTG and Ratiopharm. ST received funding for experimental research as well as honoraria for lectures from Edwards, OrionPharma, Amomed and Smith & Nephews outside this work.

Figures

Fig. 1
Fig. 1
Timeline recruitment periods. Gray: control group, blue: colloid group, orange: crystalloid group
Fig. 2
Fig. 2
Patients enrollment—ITT
Fig. 3
Fig. 3
Complication rates between the three groups
Fig. 4
Fig. 4
Total length of stay in the recovery room. The circles indicate outliers that lie outside the lower and upper quartiles
See this image and copyright information in PMC

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