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What is IOFM?

The promotion of optimal fluid balance and the prevention of complications resulting from abnormal or undesired fluid levels (hypovolaemia or hypervolaemia) in the operating theatre and critical care areas.

Intraoperative fluid management (IOFM) is the management of an individual patient’s fluid and cardiovascular status perioperatively to improve outcomes, such as reduced morbidity and length of stay. It is a crucial factor for prevention of occult hypovolaemia and subsequent end organ dysfunction. IOFM is now a vital element of any Enhanced Recovery Programme and is one of six High Impact Innovations.

There is a large evidence base to support IOFM. ODM is the only technology to consistently demonstrate reductions in postoperative complications and length of hospital stay when used to guide IOFM. See the Evidence Table for a summary of IOFM outcome studies.

Why is IOFM Important?

Up to 70% of patients may exhibit hypovolaemia (a reduced circulating blood volume) at the beginning of surgery [1]. The maintenance of adequate blood volume is essential for the delivery of oxygen. The body responds to hypovolaemia reducing blood flow to some organ systems (i.e. the gut), to ensure adequate supply is maintained to the vital organs (i.e. the heart and brain). This decreased blood and oxygen supply to the gut can cause tissue necrosis, triggering the leakage of bacteria and toxins from the gut into the bloodstream. These events can result in postoperative complications ranging from nausea and vomiting to multiple organ failure [2,3].

By optimising a patient’s blood flow (see Stroke Volume Optimisation) during surgery, postoperative complications attributed to hypovolaemia may be avoided.

 1. Bundgaard-Nielson, M. et al, Functional intravascular volume deficit in patients before surgery, Acta Anaesthesiol Scand, 2010. 54(4): p.464-9.
2. Deitch, EA, The role of intestinal barrier failure and bacterial translocation in the development of systemic infection and multiple organ failure, Arch Surg, 1990. 125(3): p.403-4.
3. Fiddian-Green, RG, Splanchnic ischaemia and multiple organ failure in the critically ill, Ann R Coll Surg Engl, 1988. 70(3): p.128-34.

Recommended by NICE

NICE released its recommendation on the CardioQ-ODM on 30 March 2011. 

Evidence-based recommendations and conclusions:

  • CardioQ-ODM specific recommendation
  • For major and high-risk surgery
  • Reduces post-operative complications
  • Shortens length of stay
  • Saves £1,100 per patient

The case for adopting the CardioQ-ODM in the NHS,…is supported by the evidence…The CardioQ-ODM should be considered for use in patients undergoing major or high-risk surgery or other surgical patients in whom a clinician would consider using invasive cardiovascular monitoring. This will include patients undergoing major or high-risk surgery or high-risk patients undergoing intermediate-risk surgery.

NICE, 2011

See NICE for further information.