Improved Outcomes

IMPROVED OUTCOMES

Use of the oesophageal Doppler for IOFM has been shown to improve patient outcome, in both randomised trials [1-15] and clinical audits [16-20], across a number of different surgical specialties, by reducing the incidence of postoperative complications and length of hospital stay. Although the majority of outcome evidence is from the intraoperative setting, outcome studies have also been published following the use of Doppler-guided fluid management postoperatively, and in intensive care [21-23].

The UK’s National Institute for Health and Care Excellence (NICE) produced guidance on the CardioQ-ODM, recommending its use for IOFM in patients undergoing “major or high-risk surgery or other surgical patients in whom a clinician would consider using invasive cardiovascular monitoring.”

A recent meta-analysis confirms that only the oesophageal Doppler technology is able to bring these benefits (see the table above).

The Evidence Table also compares studies from the available technologies and their impact on patient outcome.

References

  1. Brandstrup, B., et al., Which goal for fluid therapy during colorectal surgery is followed by the best outcome: near-maximal stroke volume or zero fluid balance? Br J Anaesth, 2012. 109(2): p. 191-9.
  2. Challand, C., et al., Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery. Br J Anaesth, 2012. 108(1): p. 53-62.
  3. Conway, D.H., et al., Randomised controlled trial investigating the influence of intravenous fluid titration using oesophageal Doppler monitoring during bowel surgery. Anaesthesia, 2002. 57(9): p. 845-9.
  4. El Sharkawy, O.A., et al., Transoesophageal Doppler compared to central venous pressure for perioperative hemodynamic monitoring and fluid guidance in liver resection. Saudi J Anaesth, 2013. 7(4): p. 378-86.
  5. Gan, T.J., et al., Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology, 2002. 97(4): p. 820-6.
  6. McKenny, M., et al., A randomised prospective trial of intra-operative oesophageal Doppler-guided fluid administration in major gynaecological surgery. Anaesthesia, 2013. 68(12): p. 1224-31.
  7. Mythen, M.G. and A.R. Webb, Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg, 1995. 130(4): p. 423-9.
  8. Noblett, S.E., et al., Randomized clinical trial assessing the effect of Doppler-optimized fluid management on outcome after elective colorectal resection. Br J Surg, 2006. 93(9): p. 1069-76.
  9. Pillai, P., et al., A double-blind randomized controlled clinical trial to assess the effect of Doppler optimized intraoperative fluid management on outcome following radical cystectomy. J Urol, 2011. 186(6): p. 2201-6.
  10. Senagore, A.J., et al., Fluid management for laparoscopic colectomy: a prospective, randomized assessment of goal-directed administration of balanced salt solution or hetastarch coupled with an enhanced recovery program. Dis Colon Rectum, 2009. 52(12): p. 1935-40.
  11. Sinclair, S., S. James, and M. Singer, Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. BMJ, 1997. 315(7113): p. 909-12.
  12. Srinivasa, S., et al., Randomized clinical trial of goal-directed fluid therapy within an enhanced recovery protocol for elective colectomy. Br J Surg, 2013. 100(1): p. 66-74.
  13. Venn, R., et al., Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures. Br J Anaesth, 2002. 88(1): p. 65-71.
  14. Wakeling, H.G., et al., Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth, 2005. 95(5): p. 634-42.
  15. Zakhaleva, J., et al., The impact of intravenous fluid administration on complication rates in bowel surgery within an enhanced recovery protocol: a randomized controlled trial. Colorectal Dis, 2013. 15(7): p. 892-9.
  16. Chattopadhyay, S., et al., The role of intraoperative fluid optimization using the esophageal Doppler in advanced gynecological cancer: early postoperative recovery and fitness for discharge. Int J Gynecol Cancer, 2013. 23(1): p. 199-207.
  17. Feldheiser, A., et al., Development and feasibility study of an algorithm for intraoperative goal-directed haemodynamic management in noncardiac surgery. J Int Med Res, 2012. 40(4): p. 1227-41.
  18. Figus, A., et al., Intraoperative esophageal Doppler hemodynamic monitoring in free perforator flap surgery. Ann Plast Surg, 2013. 70(3): p. 301-7.
  19. Mannova, J.H., et al., Perioperative haemodynamic monitoring by oesophageal Doppler improves outcome of patients with abdominal aortic aneurysm repair. Bratisl Lek Listy, 2013. 114(2): p. 78-83.
  20. McKenny, M., et al., Introduction of oesophageal Doppler-guided fluid management in a laparoscopic colorectal surgery enhanced recovery programme: an audit of effect on patient outcome. Ir Med J, 2014. 107(5): p. 135-8.
  21. Chytra, I., et al., Esophageal Doppler-guided fluid management decreases blood lactate levels in multiple-trauma patients: a randomized controlled trial. Crit Care, 2007. 11(1): p. R24.
  22. McKendry, M., et al., Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery. BMJ, 2004. 329(7460): p. 258.
  23. van Dellen, J., S. McCorkell, and A. Williams, Randomised controlled trial of extended post-operative goal-directed fluid therapy using oesophageal doppler within an enhanced recovery programme for elective colorectal patients [Abstract P056]. Colorectal Dis, 2013. 15(Suppl 1): p. 30.