Key result
In preoperative hip fracture patients, hypovolemia after epidural analgesia was significantly associated with a peripheral perfusion index ≤1.5 compared to non-hypovolemic patients (53% vs 9%, p=0.001).
Why the study?
Preoperative resuscitation strategies in patients with hip fracture are lacking.
How do fluid-responsiveness, peripheral perfusion index, and blood volume status change before and after lumbar epidural analgesia in preoperative hip fracture patients?
Observational (n=50)
How do fluid-responsiveness, peripheral perfusion index, and blood volume status change before and after lumbar epidural analgesia in preoperative hip fracture patients?
Absolute Event Rate: 53% vs 9%
p-value: p=.001
Peripheral perfusion index may be associated with blood volume and could support clinicians during perioperative hemodynamic optimization in hip fracture patients.
Peripheral perfusion index ≤1.5 may signal hypovolemia after epidural in hip fracture patients; hypothesis-generating and requires prospective validation.
BACKGROUND: Preoperative resuscitation strategies in patients with hip fracture (HF) are lacking. We aimed to investigate fluid-responsiveness, peripheral perfusion index (PPI) and blood volume (BV)-status in patients with HF undergoing resuscitation in the preoperative phase. METHODS: In a prospective observational study, we evaluated preoperative fluid-responsiveness, indices of perfusion and BV before and after lumbar epidural analgesia in 50 patients with HF shortly after admittance. RESULTS: Initially, 18 (36%) patients were fluid-responsive (≥10% increased SV in response to 250 ml fluid bolus) and 13 (26%) presented hypovolaemia (deviation of measured BV from estimated BV ≤ 0.9). According to fluid-responsiveness, no difference in absolute values of cardiac index (CI) (2.7 L [2.1-3.3] vs. 2.8 L [2.3-3.4], p = .5) was seen, but cardiac output (CO) rose significantly in the hypovolaemic patients: 9% [5-18] vs. 1% [-3-7], p = .004. After epidural analgesia, 26 (52%) patients were again fluid-responsive and 15 (30%) were hypovolaemic. CI was now significantly lower in fluid-responsive patients (2.2 L [1.7-2.7] vs. 2.9 L [2.3-3.5], p = .001). Prior to epidural analgesia, no significant trend towards hypovolaemic patients having lower indices of perfusion was seen. After epidural analgesia, more patients with hypovolaemia presented with PPI≤1.5 (8 (53%) vs. 3 (9%), p = .001) and absolute values of PPI were also significantly lower if IBV was low (1.4 [0.9-3.2] vs. 3.2 [2.4-4.8], p = .01). PPI correlated with hypovolaemia after epidural analgesia (rho 0.4 [0.1-0.7], p = .007). CONCLUSIONS: Preoperative fluid-responsivity in HF patients might be attributable to elements of hypovolaemia and sympathetic compensatory ability conjointly, confounding the use of SV-guided resuscitation. PPI could be associated with BV, which may support clinicians during perioperative haemodynamic optimisation.
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Agerskov et al. (2022) conducted an observational in Hip fracture (n=50). Hypovolaemia vs. Non-hypovolaemia was evaluated on Peripheral perfusion index (PPI) ≤1.5 after epidural analgesia (p=.001). In preoperative hip fracture patients, hypovolemia after epidural analgesia was significantly associated with a peripheral perfusion index ≤1.5 compared to non-hypovolemic patients (53% vs 9%, p=0.001).
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