the Effects of Perioperative Goal Directed and Conventional Fluid Management on the IVC Collapsibility Index
Condition: Femoral Neck Fractures
MeSH terms: Femoral Neck Fractures
Study type: Interventional

Summary: 
      The investigators aimed to compare the effects of targeted fluid management and traditional
      fluid management on the inferior vena cava collapsibility index in participants who will
      undergo proximal femoral surgery. In addition, the amount of fluid given, blood products, the
      number of perioperative hypotensive events, perioperative hemodynamics, perioperative and
      postoperative blood gas analysis, perioperative urine output and bleeding amount,
      postoperative complications (cardiac, respiratory, renal, etc.), postoperative 30-day
      mortality, nausea and vomiting score, It was aimed to evaluate and compare the postoperative
      hospitalization day as secondary.
    

Detailed description: 
      Hip fracture surgeries have become one of the most frequently performed surgeries with the
      increase in the aging population in recent years. Perioperative fluid management of geriatric
      patients who become prone to dehydration due to malnutrition, decreased functional capacity,
      impaired cognitive functions after hip fracture development; It is important in terms of
      reducing complications in the postoperative period and perioperative hemodynamics.

      The traditional approach to perioperative fluid administration is the fluid deficit for the
      fasting period with the '4-2-1' rule (4ml/kg/hr for the first 10 kg, 2ml/kg/hr for the second
      10 kg, 1ml/kg/hr for each subsequent kg). ) calculation. The fluid and blood losses in the
      surgical area and the fluid deficit are estimated and replaced. In order to replace the
      volume deficit caused by blood loss, crystalloid is used 3 times the amount of bleeding,
      taking into account the crystalloid movement into the extravascular compartment. Static
      parameters such as blood pressure, heart rate, and urine volume, which are followed in fluid
      management with the traditional approach, support the estimation of intravascular volume.

      Maintaining intravascular euvolemia throughout the perioperative period is ideal. Both
      hypovolemia and hypervolemia are associated with increased postoperative morbidity. While
      vasoconstriction due to hypovolemia, decreased oxygen delivery, decreased tissue perfusion
      and dysfunction in peripheral organs can be observed; Tissue edema due to hypervolemia,
      impaired tissue perfusion, local inflammation, delayed wound healing, wound infection and
      anastomotic leaks can be seen. There is no clear consensus on how to perform optimal fluid
      management in this population, which has many comorbidities and is at high risk for
      postoperative complications.

      The search for an optimal fluid regimen to avoid excessive intravascular volume overload and
      maximize tissue perfusion has brought individualized targeted fluid replacement therapies
      with the help of developing technology. In the targeted therapy (HYT) approach, basic
      physiological variables related to cardiac output or global O2 distribution are measured with
      the aim of improving tissue perfusion and clinical outcome. Replacement by crystalloid,
      colloid or blood products is adjusted according to the dynamic process according to the
      measured physiological variables. Methods such as pulmonary artery catheter, esophageal
      doppler, central venous pressure measurement, echocardiography, lactate, central venous
      saturation, thoracic bioimpedance and arterial waveform analysis can be used to determine
      physiological targets.

      Arterial waveform analysis provides estimation of cardiac output based on continuous analysis
      of the waveform, a complex physiological signal determined by the interaction of left
      ventricular stroke volume, systemic vascular resistance, and vascular compliance. Arterial
      waveform analysis stands out because it can measure continuous cardiac output and does not
      require a central venous catheter. There are invasive, minimally invasive and non-invasive
      waveform monitoring systems.

      One of the methods used in the evaluation of intravascular volume status is the evaluation of
      the diameter of the inferior vena cava (IVC) and its collapsibility, which changes with
      respiration. It can be done at the bedside, it is a fast and noninvasive method.

      Inferior vena cava collapsibility index (cIVC) can be used as an indicator of fluid response
      and a guide in fluid management in critically ill breathing spontaneously.

      Several meta-analyses have reported that individualized targeted perioperative fluid
      managements reduce organ-specific complications in patients undergoing major surgery. In a
      study, it was stated that targeted fluid therapy in patients with proximal femur fractures
      decreased the total amount of fluid administered and could reduce postoperative
      complications.

      Although the necessity of providing adequate intravascular volume in perioperative fluid
      management is obvious, an optimal fluid management guideline has not been established in
      geriatric and emergency cases with high mortality. The investigators aimed to compare the
      cIVC measurements and perioperatively administered fluid volumes of the patients who the
      investigators performed fluid management with the arterial waveform analysis method, which
      measures the minimally invasive continuous cardiac output, and the patients with whom the
      investigators had fluid management with traditional methods, and to examine the postoperative
      effects.
    

Intervention name(s): mostcare hemodynamic monitor
Intervention type(s): Drug
Intervention description(s): mostcare hemodynamic monitoring integrated into the radial artery catheter. According to the data obtained, intraoperative fluid management was arranged with certain algorithms.
Other intervention name(s): minimally invasive cardiac output monitors
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A total of 60 patients over the age of 65, who were scheduled for proximal femoral surgery due to intertochanteric fracture, and operated with ASA1-3 risk will be included in the study. The patients will be randomized into two groups as Group K (n=30) and Group H (n=30) by the closed envelope method and the patients will not know their groups.
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Health Services Research
Keywords: intraoperative care, hemodynamic monitoring, fluid therapy