S R Walsh1, T Tang, S Bass, M E Gaunt. 1. Department of General Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. srwalsh@doctors.org.uk
Abstract
BACKGROUND: Peri-operative fluid therapy is a controversial area with few randomised trials to guide practice. Recently, a number of trials have suggested that intra-operative therapy guided by oesophageal Doppler acquired haemodynamic variables may improve postoperative outcome. METHODS: Abstract databases and conference proceedings were searched to identify randomised controlled trials comparing Doppler-guided intra-operative fluid management to standard practice in patients undergoing major abdominal surgery. Pooled odds ratios (POR) and weighted mean differences (WMD) were calculated for categorical and continuous outcomes respectively. RESULTS: Four trials, comprising 393 patients, were identified. Use of an oesophageal Doppler-guided fluid management algorithm resulted in fewer postoperative complications (POR 0.32; 95% CI: 0.19-0.52; p < 0.0001) and shorter hospital stays (WMD 1.68 days; 95% CI: 2.39-0.98; p < 0.0001). There were no significant differences in the quantities of intra-operative fluids administered although there was some evidence of heterogeneity with respect to this outcome. CONCLUSION: Oesophageal Doppler-guided fluid management may improve outcome following major intra-abdominal surgery. However, comparison with fluid restriction strategies, including a cost-effectiveness analysis are required.
BACKGROUND: Peri-operative fluid therapy is a controversial area with few randomised trials to guide practice. Recently, a number of trials have suggested that intra-operative therapy guided by oesophageal Doppler acquired haemodynamic variables may improve postoperative outcome. METHODS: Abstract databases and conference proceedings were searched to identify randomised controlled trials comparing Doppler-guided intra-operative fluid management to standard practice in patients undergoing major abdominal surgery. Pooled odds ratios (POR) and weighted mean differences (WMD) were calculated for categorical and continuous outcomes respectively. RESULTS: Four trials, comprising 393 patients, were identified. Use of an oesophageal Doppler-guided fluid management algorithm resulted in fewer postoperative complications (POR 0.32; 95% CI: 0.19-0.52; p < 0.0001) and shorter hospital stays (WMD 1.68 days; 95% CI: 2.39-0.98; p < 0.0001). There were no significant differences in the quantities of intra-operative fluids administered although there was some evidence of heterogeneity with respect to this outcome. CONCLUSION: Oesophageal Doppler-guided fluid management may improve outcome following major intra-abdominal surgery. However, comparison with fluid restriction strategies, including a cost-effectiveness analysis are required.
Authors: Beren Semiz; Andrew M Carek; Jessica C Johnson; Shireen Ahmad; J Alex Heller; Florencia G Vicente; Stacey Caron; Charles W Hogue; Mozziyar Etemadi; Omer T Inan Journal: IEEE J Biomed Health Inform Date: 2021-05-11 Impact factor: 5.772