Perioperative fluid volume optimization following proximal femoral fracture

Price, James D.; Sear, J; Venn, Richard

doi:10.1002/14651858.cd003004

Cited by 23 publications

(23 citation statements)

References 16 publications

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“…However, fluid status is not always easy to determine clinically in elderly patients, and given their reduced cardiovascular reserve, fluid overload is possible. The concept of aggressive fluid resuscitation guided by invasive blood pressure monitoring in patients with hip fracture has emerged in recent years [32], but few hospitals offer this level of input because of restrictions in high-dependency unit bed availability and unproven efficacy. More research is required before this type of protocol can be routinely recommended because the long-term benefits and potential for increased mortality are unknown [32].…”

Section: Systematic Preparation Of the Patient For Early Surgerymentioning

confidence: 99%

How to optimize patients for geriatric fracture surgery

et al. 2010

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Low-energy fragility fractures account for >80% of fractures in elderly patients, and with aging populations, geriatric fracture surgery makes up a substantial proportion of the orthopedic workload. Elderly patients have markedly less physiologic reserve than do younger patients, and comorbidity is common. Even with optimal care, the risk of mortality and morbidity remains high. Multidisciplinary care, including early orthogeriatric input, is recommended to anticipate and treat complications. This article explores modern treatment strategies for this challenging group of patients and provides guidance for systematically preparing and optimizing elderly patients before surgery, based on best available current evidence and recommendations by relevant health organizations.

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Section: Systematic Preparation Of the Patient For Early Surgerymentioning

confidence: 99%

How to optimize patients for geriatric fracture surgery

et al. 2010

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“…A meta-analysis of two studies, randomising a total of 130 patients, to determine the optimal method of fluid volume optimisation for adult patients undergoing surgical repair of hip fracture has been undertaken by the Cochrane group of reviewers (Price et al 2002). Both studies involved invasive advanced haemodynamic monitoring during the intra-operative period only.…”

Section: Consequences Of Salt and Water Imbalancementioning

confidence: 99%

Fluid, electrolytes and nutrition: physiological and clinical aspects

Lobo

2004

Proc. Nutr. Soc.

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Fluid and electrolyte balance is often poorly understood and inappropriate prescribing can cause increased post-operative morbidity and mortality. The efficiency of the physiological response to a salt or water deficit, developed through evolution, contrasts with the relatively inefficient mechanism for dealing with salt excess. Saline has a Na + :Cl -of 1 :1 and can produce hyperchloraemic acidosis, renal vasoconstriction and reduced glomerular filtration rate. In contrast, the more physiological Hartmann's solution with a Na + :Cl -of 1 . 18 :1 does not cause hyperchloraemia and Na excretion following infusion is more rapid. Salt and water overload causes not only peripheral and pulmonary oedema, but may also produce splanchnic oedema, resulting in ileus or acute intestinal failure. This overload may sometimes be an inevitable consequence of resuscitation, yet it may take 3 weeks to excrete this excess. It is important to avoid unnecessary additional overload by not prescribing excessive maintenance fluids after the need for resuscitation has passed. Most patients require 2-2 . 5 litres water and 60-100 mmol Na/d for maintenance in order to prevent a positive fluid balance. This requirement must not be confused with those for resuscitation of the hypovolaemic patient in whom the main aim of fluid therapy is repletion of the intravascular volume. Fluid and electrolyte balance is a vital component of the metabolic care of surgical and critically-ill patients, with important consequences for gastrointestinal function and hence nutrition. It is also of importance when prescribing artificial nutrition and should be given the same careful consideration as other nutritional and pharmacological needs.

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“…In einem Chorane Review [109] wurden 3 dieser Arbeiten [50,125,137] und eine weitere von Schultz et al (1985) [118] zusammengefasst. Demnach können durch die Anwendung eines invasiven Flüssig-keitsmonotorings bei proximalen Femurfrakturen kurzzeitige Erfolge verzeichnet werden, im Besonderen durch eine Reduktion der postoperativen Verweildauer.…”

Section: Tab 6 Intraoperative Flüssigkeitsgabe: Outcome-orientiert -unclassified

“…Jedoch weisen die Autoren ausdrücklich daraufhin, dass aufgrund der zu geringen Patientenzahl ein Einfluss auf die Letalität nicht nachgewiesen werden konnte und eine Möglichkeit der Gefährdung des Patienten dementsprechend nicht ausgeschlossen werden kann. Nur eine Patientenzahl von n=1000 würde diese Fragen klären [109].…”

Section: Tab 6 Intraoperative Flüssigkeitsgabe: Outcome-orientiert -unclassified

Perioperative fluid management

Zausig

Weigand²,

Graf

2006

Anaesthesist

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Optimal perioperative fluid management is still controversial. Besides well known perioperative hypovolaemia, hypervolaemia has an influence on perioperative morbidity and mortality, particularly with regard to the patient's medical history, a reduced cardiac and pulmonal function and the operation itself. The concepts of preoperative, intraoperative and postoperative fluid administration are neither adequately validated, nor sufficiently integrated into a perioperative concept. At the present, moderate fluid administration to improve preoperative and postoperative outcome is safe in minor or medium surgical procedures. High-risk surgical patients benefit from a time-oriented or/and goal-oriented monitored fluid therapy. In the past only little attention has been concentrated on postoperative fluid management, but may be stimulated by the new concepts of fast track surgery.

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Perioperative fluid volume optimization following proximal femoral fracture

Cited by 23 publications

References 16 publications

How to optimize patients for geriatric fracture surgery

How to optimize patients for geriatric fracture surgery

Fluid, electrolytes and nutrition: physiological and clinical aspects

Perioperative fluid management

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