Letters

Intravascular volume optimisation during repair of proximal femoral fracture

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7137.1089a (Published 04 April 1998) Cite this as: BMJ 1998;316:1089

Intravascular volume was depleted perioperatively in control group

  1. KW Toh, Senior house officer in anaesthesia,
  2. W J Fawcett, Consultant anaesthetist
  1. Royal Surrey County Hospital Trust, Guildford, Surrey GU2 5XX
  2. Peterborough Hip Fracture Project, Peterborough Hospitals NHS Trust, Peterborough District Hospital, Peterborough PE3 6DA
  3. Department of Anaesthesia, Meath Hospital, Dublin 8, Republic of Ireland
  4. University College London Medical School, London WC1E 6JJ
  5. Whipps Cross Hospital, London E11 1NR

    EDITOR—In their study investigating intravascular volume optimisation and proximal femoral fracture, Sinclair et al have a different approach to fluid replacement between the two groups studied.1 The control group received only a median volume of 1000 ml of crystalloid (presumably Hartmann's or 0.9% saline solution) peroperatively. As only about a quarter of this solution is retained intravascularly, these patients effectively had a depleted intravascular volume perioperatively. In contrast, the protocol group received a median of 750 ml of colloid as well as 725 ml of crystalloid, giving intravascular fluid replacement of nearly 1 litre. The preoperative dextrose-saline maintenance fluids would have had minimal effect on the intravascular volume: only 15% of such a solution is retained within the intravascular compartment.

    This study merely shows that patients who have not received fluid or who have fluid depletion have a higher rate of complications, which is not a surprising or new finding. A control group should be recognisable as such; if the control group has been deprived of fluid then this will magnify any benefits in the protocol group. We suggest that if adequate preoperative intravascular fluids, and not just dextrose-saline maintenance fluids, had been given to all patients, replacing the blood loss associated with femoral fractures (often in excess of 1 litre2), then the differences between the groups would have been much less. A study comparing a group in whom optimisation is used with a group given sufficient fluid would be of much greater importance and would show the benefits of optimisation more clearly.

    References

    1. 1.
    2. 2.

    Differences in outcome were probably due to chance

    1. Martyn J Parker, Orthopaedic research fellow
    1. Royal Surrey County Hospital Trust, Guildford, Surrey GU2 5XX
    2. Peterborough Hip Fracture Project, Peterborough Hospitals NHS Trust, Peterborough District Hospital, Peterborough PE3 6DA
    3. Department of Anaesthesia, Meath Hospital, Dublin 8, Republic of Ireland
    4. University College London Medical School, London WC1E 6JJ
    5. Whipps Cross Hospital, London E11 1NR

      EDITOR—Sinclair et al's randomised controlled trial of intraoperative intravascular volume optimisation in patients with proximal femoral fracture raises important issues regarding the preoperative administration of fluid to …

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