Evaluation of hemodynamic goal-directed therapy to reduce the incidence of bone cement implantation syndrome in patients undergoing cemented hip arthroplasty – a randomized parallel-arm trial
Abstract Background The bone cement implantation syndrome (BCIS) is a frequent and potentially disastrous intraoperative complication in patients undergoing cemented hip arthroplasty. Several risk factors have been identified, however randomized controlled trials to reduce the incidence of BCIS are...
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| Format: | Article |
| Language: | English |
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BMC
2018-06-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12871-018-0526-4 |
| _version_ | 1818241781886615552 |
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| author | Kai B. Kaufmann Wolfgang Baar Judith Rexer Thomas Loeffler Sebastian Heinrich Lukas Konstantinidis Hartmut Buerkle Ulrich Goebel |
| author_facet | Kai B. Kaufmann Wolfgang Baar Judith Rexer Thomas Loeffler Sebastian Heinrich Lukas Konstantinidis Hartmut Buerkle Ulrich Goebel |
| author_sort | Kai B. Kaufmann |
| collection | DOAJ |
| description | Abstract Background The bone cement implantation syndrome (BCIS) is a frequent and potentially disastrous intraoperative complication in patients undergoing cemented hip arthroplasty. Several risk factors have been identified, however randomized controlled trials to reduce the incidence of BCIS are still pending. We hypothesized that goal-directed hemodynamic therapy guided by esophageal Doppler monitoring (EDM) may reduce the incidence of BCIS in a randomized, controlled parallel-arm trial. Methods After approval of the local ethics committee, 90 patients scheduled for cemented hip arthroplasty at the Medical Center – University of Freiburg were randomly assigned to either standard hemodynamic management or goal-directed therapy (GDT) guided by an esophageal Doppler monitoring-based algorithm. The primary endpoint was the incidence of overall BCIS including grade 1–3 after cementation of the femoral stem. Secondary endpoints included cardiac function, length of hospital stay and postoperative complications. Results Ninety patients were finally analyzed. With regards to the primary endpoint, the overall incidence of BCIS showed no difference between the GDT and control group. Compared to the control group, patients of the GDT group showed a higher cardiac index before and after bone cement implantation (2.7 vs. 2.2 [l●min− 1●m− 2]; 2.8 vs. 2.4 [l●min− 1●m− 2]; P = 0.003, P = 0.042), whereas intraoperative amount of fluids and mean arterial pressure did not differ. Conclusions The implementation of a specific hemodynamic goal-directed therapy did not reduce the overall incidence of BCIS in patients undergoing cemented hip arthroplasty. Trial registration This randomized clinical two-arm parallel study was approved by the local Ethics Committee, Freiburg, Germany [EK 160/15, PI: U. Goebel] and registered in the German Clinical Trials Register (DRKS No. 00008778, 16th of June, 2015). |
| first_indexed | 2024-12-12T13:34:48Z |
| format | Article |
| id | doaj.art-9027023ff79c431db39b5843fccedb40 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-12T13:34:48Z |
| publishDate | 2018-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-9027023ff79c431db39b5843fccedb402022-12-22T00:22:59ZengBMCBMC Anesthesiology1471-22532018-06-011811910.1186/s12871-018-0526-4Evaluation of hemodynamic goal-directed therapy to reduce the incidence of bone cement implantation syndrome in patients undergoing cemented hip arthroplasty – a randomized parallel-arm trialKai B. Kaufmann0Wolfgang Baar1Judith Rexer2Thomas Loeffler3Sebastian Heinrich4Lukas Konstantinidis5Hartmut Buerkle6Ulrich Goebel7Department of Anaesthesiology and Critical Care, Medical Center – University of FreiburgDepartment of Anaesthesiology and Critical Care, Medical Center – University of FreiburgDepartment of Anaesthesiology and Critical Care, Medical Center – University of FreiburgDepartment of Anaesthesiology and Critical Care, Medical Center – University of FreiburgDepartment of Anaesthesiology and Critical Care, Medical Center – University of FreiburgDepartment of Orthopaedic and Trauma Surgery, Medical Center – University of FreiburgDepartment of Anaesthesiology and Critical Care, Medical Center – University of FreiburgDepartment of Anaesthesiology and Critical Care, Medical Center – University of FreiburgAbstract Background The bone cement implantation syndrome (BCIS) is a frequent and potentially disastrous intraoperative complication in patients undergoing cemented hip arthroplasty. Several risk factors have been identified, however randomized controlled trials to reduce the incidence of BCIS are still pending. We hypothesized that goal-directed hemodynamic therapy guided by esophageal Doppler monitoring (EDM) may reduce the incidence of BCIS in a randomized, controlled parallel-arm trial. Methods After approval of the local ethics committee, 90 patients scheduled for cemented hip arthroplasty at the Medical Center – University of Freiburg were randomly assigned to either standard hemodynamic management or goal-directed therapy (GDT) guided by an esophageal Doppler monitoring-based algorithm. The primary endpoint was the incidence of overall BCIS including grade 1–3 after cementation of the femoral stem. Secondary endpoints included cardiac function, length of hospital stay and postoperative complications. Results Ninety patients were finally analyzed. With regards to the primary endpoint, the overall incidence of BCIS showed no difference between the GDT and control group. Compared to the control group, patients of the GDT group showed a higher cardiac index before and after bone cement implantation (2.7 vs. 2.2 [l●min− 1●m− 2]; 2.8 vs. 2.4 [l●min− 1●m− 2]; P = 0.003, P = 0.042), whereas intraoperative amount of fluids and mean arterial pressure did not differ. Conclusions The implementation of a specific hemodynamic goal-directed therapy did not reduce the overall incidence of BCIS in patients undergoing cemented hip arthroplasty. Trial registration This randomized clinical two-arm parallel study was approved by the local Ethics Committee, Freiburg, Germany [EK 160/15, PI: U. Goebel] and registered in the German Clinical Trials Register (DRKS No. 00008778, 16th of June, 2015).http://link.springer.com/article/10.1186/s12871-018-0526-4Hip arthroplastyPostoperative complicationsHemodynamics |
| spellingShingle | Kai B. Kaufmann Wolfgang Baar Judith Rexer Thomas Loeffler Sebastian Heinrich Lukas Konstantinidis Hartmut Buerkle Ulrich Goebel Evaluation of hemodynamic goal-directed therapy to reduce the incidence of bone cement implantation syndrome in patients undergoing cemented hip arthroplasty – a randomized parallel-arm trial BMC Anesthesiology Hip arthroplasty Postoperative complications Hemodynamics |
| title | Evaluation of hemodynamic goal-directed therapy to reduce the incidence of bone cement implantation syndrome in patients undergoing cemented hip arthroplasty – a randomized parallel-arm trial |
| title_full | Evaluation of hemodynamic goal-directed therapy to reduce the incidence of bone cement implantation syndrome in patients undergoing cemented hip arthroplasty – a randomized parallel-arm trial |
| title_fullStr | Evaluation of hemodynamic goal-directed therapy to reduce the incidence of bone cement implantation syndrome in patients undergoing cemented hip arthroplasty – a randomized parallel-arm trial |
| title_full_unstemmed | Evaluation of hemodynamic goal-directed therapy to reduce the incidence of bone cement implantation syndrome in patients undergoing cemented hip arthroplasty – a randomized parallel-arm trial |
| title_short | Evaluation of hemodynamic goal-directed therapy to reduce the incidence of bone cement implantation syndrome in patients undergoing cemented hip arthroplasty – a randomized parallel-arm trial |
| title_sort | evaluation of hemodynamic goal directed therapy to reduce the incidence of bone cement implantation syndrome in patients undergoing cemented hip arthroplasty a randomized parallel arm trial |
| topic | Hip arthroplasty Postoperative complications Hemodynamics |
| url | http://link.springer.com/article/10.1186/s12871-018-0526-4 |
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