Optimization Study of Cardiac Risk Patients With Hip Fracture
Left Ventricular Dysfunction, Femoral Fracture
About this trial
This is an interventional prevention trial for Left Ventricular Dysfunction focused on measuring NT-proBNP, non-cardiac surgery, left ventricular dysfunction, cardiac complications
Eligibility Criteria
Inclusion Criteria:
- Patients > 65 yrs
- Proximal femur fracture where the patient is planned to be operated during the day (Monday-Friday).
- NT-proBNP > 900 ng/l in patients 65-75 yrs old, and >1800 ng/l in patients > 75 yrs.
- Informed consent provided by the patient.
All of the above criteria must be fulfilled before the patient can be included in the study.
Exclusion Criteria:
- Informed consent cannot be provided
- Mental or verbal difficulty in understanding or expressing willingness to participate in the study.
- Instable angina pectoris.
- Ongoing myocardial infarct or ischemia
- Circulatory shock
- Decompensated cardiac failure or pulmonary oedema
- Pathologic femur fracture
- Chronic haemodialysis
- Cardiac valve incompetence that has haemodynamic consequences
Any one of the above is a criterion for exclusion.
Sites / Locations
- Department of Anaesthesia & Intensive Care
- Department of Anaesthesia & Intensive Care, University Hospital
- Department of Anaesthesia & Intensive Care, University Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
No Intervention
Preoperative Optimization
Standard treatment
Patients with proximal femur fracture who are > 65 yrs old and have an increased NT-proBNP would be randomized to either Standard Management or Optimized Management. The main aim of optimization is to achieve a normal oxygen delivery to the tissues preoperatively. Hb would be optimized to > 90 g/l SaO2 > 96% Stroke volume index (SVI) > 30 Heart rate should ideally be < 80 Stroke volume index (SVI) > 30 is achieved by repeated volume substitution in the form of 100-200 ml colloid. If, despite bolus doses of colloids, the SVI is < 30, one would have to use ionotropic drugs e.g. dobutamine or levosimendan, in order to achieve this goal.
Patients who are randomized to this group would be managed according to existing routines within the hospital. Consequently, these patients would be transferred to the Orthopaedic ward after initial management in the Emergency Department, including fluid therapy, oxygen and pain management. Since these patients have a significantly high NT-proBNP, a Cardiologist would be consulted and a decision for optimization taken together with the attending Anaesthesiologist and Orthopaedic Surgeon prior to surgery.