Comparison Of The Effects Of Intraoperative Goal Directed And Conventional Fluid Management On The Inferior Vena Cava Collapsibility Index And Postoperative Complications In Geriatric Patients Operated From Proximal Femoral Nail Surgery

Abstract

Introduction: Avoiding undesirable effects of hyper- and hypovolemia is important in geriatric hip fracture patients perioperatively. In our study, we aimed to compare the effects of intraoperative goal directed and conventional fluid therapy on inferior vena cava collapsibility index, postoperative complications and 30-day mortality in these patients. Materials and Methods: 60 patients aged 65 and over who underwent proximal femoral nail surgery were included in the study.Patients were randomized into two groups; Goal Directed and Conventional Therapy groups. Patients in the Goal Directed Therapy Group were monitored with a MostcareTm (Vygon, VytechHealth, Padova, Italy) haemodynamic monitor. Fluid therapy was applied by targeting Pulse Pressure Variation <10%, Stroke Volume Variation <13%. In the Conventional Therapy group fluid management was administered to the patients according to the 4-2-1 rule. Before anesthesia and leaving the recovery room, inferior vena cava collapsibility index measurements was performed by ultrasonography. Results: Postoperative inferior vena cava collapsibility index was higher in the Conventional group. Total administered crystalloid fluid volumes were similar in both the groups and more colloids were used in the Goal Directed Therapy group. Intraoperative urine output was observed more in the Goal Directed Therapy group. Postoperative hospital stay was shorter in the Goal Directed Therapy group. There was no significant difference in terms of 30-day mortality and postoperative complications. Conclusion: According to our study, intraoperative targeted fluid herapy provides optimal postoperative intravascular volume and shortened the postoperative hospital stay. Keywords: Femoral Fractures; Vena Cava, Inferior; Hemodynamic Monitoring; Fluid Therapy; Postoperative Complications.