title: Towards individualized perioperative, goal-directed haemodynamic algorithms for patients of advanced age: observations during a randomized controlled trial (NCT01141894).
abstract: BACKGROUND
  During a previous study on intraoperative goal-directed haemodynamic treatment (GDHT) in elderly patients, cardiac performance did not improve as anticipated (ClinicalTrials.gov NCT01141894). We hypothesized that in this group, responsiveness to interventions could be predicted by individual patient characteristics.
  
  
  METHODS
  Data for the present study were collected during a previously performed, single-centre, open, randomized, and controlled parallel-group superiority trial in patients aged ≥70 yr undergoing hip-fracture surgery. Haemodynamic parameters were collected by the LiDCOplus™ monitor. The GDHT group received oxygen delivery-guided fluid challenges and dobutamine infusion. Management in the routine fluid treatment group was clinician guided without access to LiDCOplus™ readings. In the GDHT group, independent predictors were assessed by multiple logistic regression analyses of two outcomes: first fluid challenge response (defined as increase of stroke volume by ≥10%); and overall intervention response (maintenance of oxygen delivery at the end of surgery).
  
  
  RESULTS
  Data from 72 routine fluid treatment and 70 GDHT patients were analysed. Clinician-guided pre-anaesthesia fluid loading increased the stroke volume in 14% of patients, and 17% of patients increased or maintained oxygen delivery at the end of surgery. The GDHT-guided first and subsequent fluid challenges were associated with increased stroke volume in 39 and 9% of patients, respectively, and increased or maintained oxygen delivery was present in 47% of patients at the end of surgery. In the GDHT group, a baseline stroke volume index (<28 ml m(-2)) was an independent predictor of first fluid challenge response, and a baseline oxygen delivery index (<330 ml min(-1) m(-2)) was a predictor of maintained or increased oxygen delivery.
  
  
  CONCLUSIONS
  Fewer patients responded to GDHT than anticipated. Our data suggest that individual characteristics could predict the haemodynamic responses.
  
  
  BACKGROUND
  NCT01141894.
authors.affiliation: Karolinska University Hospital, Huddinge, Department of Anaesthesia and Intensive Care, Karolinska Institutet, CLINTEC, Stockholm, Sweden erzsebet.bartha@karolinska.se.
authors.forename: E
authors.initials: E
authors.lastname: Bartha
authors.affiliation: Karolinska University Hospital, Huddinge, Department of Anaesthesia and Intensive Care, Karolinska Institutet, CLINTEC, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Arfwedson
authors.affiliation: Karolinska University Hospital, Huddinge, Department of Anaesthesia and Intensive Care, Karolinska Institutet, CLINTEC, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Imnell
authors.affiliation: Karolinska University Hospital, Huddinge, Department of Anaesthesia and Intensive Care, Karolinska Institutet, CLINTEC, Stockholm, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Kalman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000765:Anesthesia, Conduction; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006040:Goals; D006439:Hemodynamics; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D010102:Oxygen Inhalation Therapy / Q000379:methods; D019990:Perioperative Care / Q000379:methods* / Q000706:statistics & numerical data*; D057285:Precision Medicine / Q000379:methods*; D013318:Stroke Volume; D016896:Treatment Outcome
keywords: cardiovascular system; fluid therapy; regional anaesthesia; stroke volume