title: LiDCO-based fluid management in patients undergoing hip fracture surgery under spinal anaesthesia: a randomized trial and systematic review.
abstract: BACKGROUND
  Hip fracture is a condition with high mortality and morbidity in elderly frail patients. Intraoperative fluid optimization may be associated with benefit in this population. We investigated whether intraoperative fluid management using pulse-contour analysis cardiac monitoring, compared with standard care in patients undergoing spinal anaesthesia, would provide benefits in terms of reduced time until medically fit for discharge and postoperative complications.
  
  
  METHODS
  Patients undergoing surgical repair of fractured neck of femur, aged >60 yr, receiving spinal anaesthesia were enrolled in this single-centre, blinded, randomized, parallel group trial. Patients were allocated to either anaesthetist-directed fluid therapy or a pulse-contour-guided fluid optimization strategy using colloid (Gelofusine) boluses to optimize stroke volume. The primary outcome was time until medically fit for discharge. Secondary outcomes included postoperative complications, mobility, and mortality. We updated a systematic review to include relevant trials to 2014.
  
  
  RESULTS
  We recruited 130 patients. Time until medically fit for discharge was similar in both groups, mean [95% confidence interval (CI)] 12.2 (11.1-13.5) vs 13.1 (11.9-14.5) days (P=0.31), as was total length of stay 14.2 (12.9-15.8) vs 15.3 (13.8-17.2) days (P=0.32). There were no significant differences in complications, function, or mortality. An updated meta-analysis (four studies, 355 patients) found non-significant reduction in early mortality [relative risk 0.66 (0.24-1.79)] and in-hospital complications [relative risk 0.80 (0.61-1.05)].
  
  
  CONCLUSIONS
  Goal-directed fluid therapy during hip fracture repair under spinal anaesthesia does not result in a significant reduction in length of stay or postoperative complications. There is insufficient evidence to either support or discount its routine use.
  
  
  BACKGROUND
  ISRCTN88284896.
authors.affiliation: Anaesthesia and Critical Care, Division of Clinical Neuroscience , Queen's Medical Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham NG7 2UH, UK iain.moppett@nottingham.ac.uk.
authors.forename: I K
authors.initials: IK
authors.lastname: Moppett
authors.affiliation: Anaesthesia and Critical Care, Division of Clinical Neuroscience , Queen's Medical Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham NG7 2UH, UK.
authors.forename: M
authors.initials: M
authors.lastname: Rowlands
authors.affiliation: Anaesthesia and Critical Care, Division of Clinical Neuroscience , Queen's Medical Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham NG7 2UH, UK.
authors.forename: A
authors.initials: A
authors.lastname: Mannings
authors.affiliation: Department of Trauma and Orthopaedics, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham NG7 2UH, UK.
authors.forename: C G
authors.initials: CG
authors.lastname: Moran
authors.affiliation: Department of Anaesthetics, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK.
authors.forename: M D
authors.initials: MD
authors.lastname: Wiles
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000775:Anesthesia, Spinal; D002302:Cardiac Output / Q000502:physiology; D005265:Femoral Neck Fractures / Q000601:surgery; D005440:Fluid Therapy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008991:Monitoring, Physiologic / Q000379:methods; D010952:Plasma Substitutes / Q000008:administration & dosage; D011097:Polygeline / Q000008:administration & dosage; D011183:Postoperative Complications / Q000517:prevention & control; D013318:Stroke Volume / Q000502:physiology
chemical_list: D010952:Plasma Substitutes; D011097:Polygeline
keywords: aged; aged, 60 and over; anaesthesia, spinal; cardiac output; femoral fractures, surgery; fluid therapy, methods; haemodynamics, methods; hip fractures; infusions, i.v.; randomized controlled trial; stroke volume, physiology; treatment outcome