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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2018

Open Access 01-12-2018 | Research article

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

Authors: Kai B. Kaufmann, Wolfgang Baar, Judith Rexer, Thomas Loeffler, Sebastian Heinrich, Lukas Konstantinidis, Hartmut Buerkle, Ulrich Goebel

Published in: BMC Anesthesiology | Issue 1/2018

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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).
Literature
1.
Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370:1508–19.CrossRefPubMed
2.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–5.PubMed
3.
Smith AJ, Dieppe P, Vernon K, Porter M, Blom AW. National Joint Registry of England and Wales. Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales. Lancet. 2012;379:1199–204.CrossRefPubMed
4.
Griffiths R, White SM, Moppett IK, Parker MJ, Chesser TJS, Costa ML, et al. Safety guideline: reducing the risk from cemented hemiarthroplasty for hip fracture 2015. Anaesthesia. 2015;70:623–6.CrossRefPubMedPubMedCentral
5.
Olsen F, Kotyra M, Houltz E, Ricksten S-E. Bone cement implantation syndrome in cemented hemiarthroplasty for femoral neck fracture: incidence, risk factors, and effect on outcome. Br J Anaesth. 2014;113:800–6.CrossRefPubMed
6.
Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. Br J Anaesth. 2009;102:12–22.CrossRefPubMed
7.
Kotyra M, Houltz E, Ricksten S-E. Pulmonary haemodynamics and right ventricular function during cemented hemiarthroplasty for femoral neck fracture. Acta Anaesthesiol Scand. 2010;54:1210–6.CrossRefPubMed
8.
Urban MK, Sheppard R, Gordon MA, Urquhart BL. Right ventricular function during revision total hip arthroplasty. Anesth Analg. 1996;82:1225–9.PubMed
9.
Hamal PK, Poudel PR, Singh J. Grade III bone cement implantation syndrome in malignant lung cancer patient: a case report. BMC Anesthesiol. 2018;18:28.CrossRefPubMedPubMedCentral
10.
Sinclair S, James S, Singer M. Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. BMJ. 1997;315:909–12.CrossRefPubMedPubMedCentral
11.
Cecconi M, Fasano N, Langiano N, Divella M, Costa MG, Rhodes A, et al. Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia. Crit Care. 2011;15:R132.CrossRefPubMedPubMedCentral
12.
Venn R, Steele A, Richardson P, Poloniecki J, Grounds M, Newman P. Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures. Br J Anaesth. 2002;88:65–71.CrossRefPubMed
13.
Feldheiser A, Conroy P, Bonomo T, Cox B, Garces TR, Spies C, et al. Development and feasibility study of an algorithm for intraoperative goal-directed Haemodynamic Management in Noncardiac Surgery. J Int Med Res. 2012;40:1227–41.CrossRefPubMed
14.
Kaufmann KB, Stein L, Bogatyreva L, Ulbrich F, Kaifi JT, Hauschke D, et al. Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic surgery - a single Centre randomized parallel-arm trial. Br J Anaesth. 2017;118:852–61.CrossRefPubMed
15.
Giglio MT, Marucci M, Testini M, Brienza N. Goal-directed haemodynamic therapy and gastrointestinal complications in major surgery: a meta-analysis of randomized controlled trials. Br J Anaesth. 2009;103:637–46.CrossRefPubMed
16.
Downs EA, Isbell JM. Impact of hemodynamic monitoring on clinical outcomes. Best Pract Res Clin Anaesthesiol. 2014;28:463–76.CrossRefPubMed
17.
Sandham JD, Hull RD, Brant RF. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. NEngl J Med. 2003;348(1):5–14.CrossRef
18.
Moriyama M, Watanabe S, Hiraki T, Kano T, Okawa T, Ishibashi M. Relationship between intraoperative transoesophageal echocardiography findings and perfusion lung scintigraphy results on first postoperative day. Br J Anaesth. 2005;94:607–12.CrossRefPubMed
19.
Cholley BP, Singer M. Esophageal Doppler: noninvasive cardiac output monitor. Echocardiography. 2003;20:763–9.CrossRefPubMed
20.
Jammer I, Wickboldt N, Sander M, Smith A, Schultz MJ, Pelosi P, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European perioperative clinical outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol. 2015:88–105.
21.
Koessler MJ, Fabiani R, Hamer H, Pitto RP. The clinical relevance of embolic events detected by transesophageal echocardiography during cemented total hip arthroplasty: a randomized clinical trial. Anesth Analg. 2001;92:49–55.CrossRefPubMed
22.
Gan TJ, Soppitt A, Maroof M, el-Moalem H, Robertson KM, Moretti E, et al. Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesth. 2002;97:820–6.CrossRef
23.
Conway DH, Mayall R, Abdul-Latif MS, Gilligan S, Tackaberry C. Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery. Anaesthesia. 2002;57:845–9.CrossRefPubMed
24.
Srinivasa S, Kahokehr A, Soop M, Taylor M, Hill AG. Goal-directed fluid therapy- a survey of anaesthetists in the UK, USA, Australia and New Zealand. BMC Anesthesiol. 2013;13:5.CrossRefPubMedPubMedCentral
25.
Phan TD, D'Souza B, Rattray MJ, Johnston MJ, Cowie BS. A randomised controlled trial of fluid restriction compared to oesophageal Doppler-guided goal-directed fluid therapy in elective major colorectal surgery within an enhanced recovery after surgery program. Anaesth Intensive Care. 2014;42:752–60.PubMed
26.
Pestaña D, Espinosa E, Eden A, Nájera D, Collar L, Aldecoa C, et al. Perioperative goal-directed hemodynamic optimization using noninvasive cardiac output monitoring in major abdominal surgery: a prospective, randomized, multicenter, pragmatic trial: POEMAS study (PeriOperative goal-directed thErapy in major abdominal surgery). Anesth Analg. 2014;119:579–87.CrossRefPubMed
27.
Gómez-Izquierdo JC, Trainito A, Mirzakandov D, Stein BL, Liberman S, Charlebois P, et al. Goal-directed fluid therapy does not reduce primary postoperative ileus after elective laparoscopic colorectal surgery: a randomized controlled trial. Anesthesiology. 2017;127:36–49.CrossRefPubMed
28.
Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Åneman A, et al. Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. N. Engl. J. Med, 34. 2012;367:124.
29.
Grocott MPW, Dushianthan A, Hamilton MA, Mythen MG, Harrison D, Rowan K, et al. Perioperative increase in global blood flow to explicit defined goals and outcomes after surgery: a Cochrane systematic review. Br J Anaesth. 2013;111:535–48.CrossRefPubMed
30.
Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. 2011;112:1392–402.CrossRefPubMed
31.
Yates DRA, Davies SJ, Milner HE, Wilson RJT. Crystalloid or colloid for goal-directed fluid therapy in colorectal surgery. Br J Anaesth. 2014;112:281–9.CrossRefPubMed
32.
Pietak S, Holmes J, Matthews R, Petrasek A, Porter B. Cardiovascular collapse after femoral prosthesis surgery for acute hip fracture. Can J Anaesth. 1997;44:198–201.CrossRefPubMed
Metadata
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
Authors
Kai B. Kaufmann
Wolfgang Baar
Judith Rexer
Thomas Loeffler
Sebastian Heinrich
Lukas Konstantinidis
Hartmut Buerkle
Ulrich Goebel
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2018
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-018-0526-4

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