Luigi Vetrugno1,2, Enrico Boero3, Elena Bignami4, Andrea Cortegiani5,6, Santi Maurizio Raineri5,6, Savino Spadaro7, Federico Moro7, Stefano D'Incà8, Loris D'Orlando8, Felice Eugenio Agrò9, Mattia Bernardinetti9, Francesco Forfori10, Francesco Corradi11, Sandro Pregnolato12, Mario Mosconi13, Valentina Bellini4, Federico Franchi14, Pierpaolo Mongelli14, Salvatore Leonardi15, Clemente Giuffrida15, Marco Tescione16, Andrea Bruni17, Eugenio Garofalo17, Federico Longhini17, Gianmaria Cammarota18, Edoardo De Robertis18, Giuseppe Giglio19, Felice Urso3, Tiziana Bove8,19. 1. Department of Medicine, University of Udine, Via Colugna no. 50, 33100, Udine, Italy. luigi.vetrugno@uniud.it. 2. University-Hospital of Friuli Centrale, ASFC, P.le S. Maria della Misericordia no. 15, 33100, Udine, Italy. luigi.vetrugno@uniud.it. 3. Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy. 4. Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy. 5. Department of Surgical, Oncological and Oral Science (Di.Chir.On.S), University of Palermo, Palermo, Italy. 6. Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy. 7. Department of translational medicine, Anesthesia and Intensive Care, University of Ferrara, Ferrara, Italy. 8. Department of Medicine, University of Udine, Via Colugna no. 50, 33100, Udine, Italy. 9. Department of Medicine, Unit of Anesthesia Intensive Care Pain Management, Università Campus Bio-Medico Di Roma, Rome, Italy. 10. Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy. 11. Department of Anesthesia and Intensive Care, Ente Ospedaliero Ospedali Galliera, Genova, Italy. 12. Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy. 13. Orthopedics and Traumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 14. Department of Medicine, Surgery and Neuroscience, Anesthesiology and Intensive Care, University of Siena, Siena, Italy. 15. IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy. 16. Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy. 17. Anesthesia and Intensive Care Unit, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy. 18. Section of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, University of Perugia, Perugia, Italy. 19. University-Hospital of Friuli Centrale, ASFC, P.le S. Maria della Misericordia no. 15, 33100, Udine, Italy.
Abstract
BACKGROUND: Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of "indirect" and "direct" cardiac and pulmonary lung ultrasound signs. METHODS: LUSHIP is an Italian multicenter prospective observational study. Patients will be recruited on a nation-wide scale in the 12 participating centers. Patients aged > 65 years undergoing spinal anesthesia for hip fracture fixation will be enrolled. A lung ultrasound score (LUS) will be generated based on the examination of six areas of each lung and ascribing to each area one of the four recognized aeration patterns-each of which is assigned a subscore of 0, 1, 2, or 3. Thus, the total score will have the potential to range from a minimum of 0 to a maximum of 36. The association between 30-day postoperative complications of cardiac and/or pulmonary origin and the overall mortality will be studied. Considering the fact that cardiac complications in patients undergoing hip surgery occur in approx. 30% of cases, to achieve 80% statistical power, we will need a sample size of 877 patients considering a relative risk of 1.5. CONCLUSIONS: Lung ultrasound (LU), as a tool within the anesthesiologist's armamentarium, is becoming increasingly widespread, and its use in the preoperative setting is also starting to become more common. Should the study demonstrate the ability of LU to predict postoperative cardiac and pulmonary complications in hip fracture patients, a randomized clinical trial will be designed with the scope of improving patient outcome. Trial registration ClinicalTrials.gov, NCT04074876. Registered on August 30, 2019.
BACKGROUND:Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of "indirect" and "direct" cardiac and pulmonary lung ultrasound signs. METHODS: LUSHIP is an Italian multicenter prospective observational study. Patients will be recruited on a nation-wide scale in the 12 participating centers. Patients aged > 65 years undergoing spinal anesthesia for hip fracture fixation will be enrolled. A lung ultrasound score (LUS) will be generated based on the examination of six areas of each lung and ascribing to each area one of the four recognized aeration patterns-each of which is assigned a subscore of 0, 1, 2, or 3. Thus, the total score will have the potential to range from a minimum of 0 to a maximum of 36. The association between 30-day postoperative complications of cardiac and/or pulmonary origin and the overall mortality will be studied. Considering the fact that cardiac complications in patients undergoing hip surgery occur in approx. 30% of cases, to achieve 80% statistical power, we will need a sample size of 877 patients considering a relative risk of 1.5. CONCLUSIONS: Lung ultrasound (LU), as a tool within the anesthesiologist's armamentarium, is becoming increasingly widespread, and its use in the preoperative setting is also starting to become more common. Should the study demonstrate the ability of LU to predict postoperative cardiac and pulmonary complications in hip fracturepatients, a randomized clinical trial will be designed with the scope of improving patient outcome. Trial registration ClinicalTrials.gov, NCT04074876. Registered on August 30, 2019.
Authors: T H Lee; E R Marcantonio; C M Mangione; E J Thomas; C A Polanczyk; E F Cook; D J Sugarbaker; M C Donaldson; R Poss; K K Ho; L E Ludwig; A Pedan; L Goldman Journal: Circulation Date: 1999-09-07 Impact factor: 29.690
Authors: Lee A Fleisher; Kirsten E Fleischmann; Andrew D Auerbach; Susan A Barnason; Joshua A Beckman; Biykem Bozkurt; Victor G Davila-Roman; Marie D Gerhard-Herman; Thomas A Holly; Garvan C Kane; Joseph E Marine; M Timothy Nelson; Crystal C Spencer; Annemarie Thompson; Henry H Ting; Barry F Uretsky; Duminda N Wijeysundera Journal: J Nucl Cardiol Date: 2015-02 Impact factor: 5.952
Authors: Steen Dalby Kristensen; Juhani Knuuti; Antti Saraste; Stefan Anker; Hans Erik Bøtker; Stefan De Hert; Ian Ford; Jose Ramón Gonzalez Juanatey; Bulent Gorenek; Guy Robert Heyndrickx; Andreas Hoeft; Kurt Huber; Bernard Iung; Keld Per Kjeldsen; Dan Longrois; Thomas F Luescher; Luc Pierard; Stuart Pocock; Susanna Price; Marco Roffi; Per Anton Sirnes; Miguel Sousa Uva; Vasilis Voudris; Christian Funck-Brentano Journal: Eur J Anaesthesiol Date: 2014-10 Impact factor: 4.330
Authors: Stefan De Hert; Sven Staender; Gerhard Fritsch; Jochen Hinkelbein; Arash Afshari; Gabriella Bettelli; Matthias Bock; Michelle S Chew; Mark Coburn; Edoardo De Robertis; Hendrik Drinhaus; Aarne Feldheiser; Götz Geldner; Daniel Lahner; Andrius Macas; Christopher Neuhaus; Simon Rauch; Maria Angeles Santos-Ampuero; Maurizio Solca; Nima Tanha; Vilma Traskaite; Gernot Wagner; Frank Wappler Journal: Eur J Anaesthesiol Date: 2018-06 Impact factor: 4.330
Authors: Michael J Blaha; Rupert K Hung; Zeina Dardari; David I Feldman; Seamus P Whelton; Khurram Nasir; Roger S Blumenthal; Clinton A Brawner; Jonathan K Ehrman; Steven J Keteyian; Mouaz H Al-Mallah Journal: Heart Date: 2016-01-05 Impact factor: 5.994