Perioperative Fluid Variation
A large observational database study: 499 USA centres, 4-year duration.1
1 Thacker et al. Perioperative Fluid Utilization Variability and Association With Outcomes. Ann Surg 2015;17:in press.
Variation in Fluid Utilisation
Small studies have suggested variation in perioperative fluid delivery:1,2
- patient-to-patient
- institution-to-institution
Questions exist regarding the impact of variation in fluid management across surgical practice.1
Fluid optimisation
“We should aspire to give patients just the right amount of fluid…if we do give them too much or too little, we believe that is associated with significant harm.”
Professor Michael Mythen
1 Lilot et al. Br J Anaesth 2015;114:767-76.
2 Minto and Mythen. Br J Anaesth 2015;114:717-21.
Key Findings
Wide patient-to-patient variation.1
1 Thacker et al. Perioperative Fluid Utilization Variability and Association With Outcomes. Ann Surg 2015;17:in press.
Key Findings
Wide institution-to-institution variation – independant of variables.1
1 Thacker et al. Perioperative Fluid Utilization Variability and Association With Outcomes. Ann Surg 2015;17:in press.
Variation Influences Outcome
In colon surgery, low and high fluid utilisation were associated with higher odds of postoperative ileus, increased length of stay (LOS) and higher costs than those patients in the middle optimal zone.1
Evaluation by type of surgery showed no statistical difference in mean fluid utilisation for laparoscopy compared with traditional ‘open’ surgery. However, outcomes were statistically significantly worse for those patients receiving suboptimally low or high amounts of fluid.1
1 Thacker et al. Perioperative Fluid Utilization Variability and Association With Outcomes. Ann Surg 2015;17:in press.
Advance Monitoring
Fluid optimisation would likely lead to decreased variability and improved outcomes.1
Professor Michael ‘Monty’ Mythen, Anaesthesia and Critical Care, University College London comments on this research.
What are the key findings of the Perioperative Fluid Variation Study?
Why is this significant?
1 Thacker et al. Ann Surg 2015;17:in press.
Safety Matters
Fluid optimisation has a role in safe practice.
Professor Michael ‘Monty’ Mythen, Anaesthesia and Critical Care, University College London comments on this research.1
What should these results mean for clinical practice?
1 Thacker et al. Ann Surg 2015;17:in press.
Evidence-Based Fluid Managment
There is extensive evidence to show the benefit of precise cardiac output measurement with oesophageal Doppler monitoring in clinical trials.1-4
Yet, compliance is an issue and concordance with enhanced recovery protocols in colorectal surgery has been shown to significantly reduce:
- length of hospital stay5-8
- hospital readmission9
Furthermore, protocol deviation is predictive of delayed hospital discharge.10
1 Noblett et al. Br J Surg 2006;93:1069-76.
2 Wakeling et al. Br J Anaesth 2005;95:634-42.
3 Sinclair et al. BMJ 1997;315:909-12.
4 Gan et al. Anesthesiology 2002;97:820-6.
5 Rona et al. Am Surg 2012;78:1041-4.
6 ERAS Compliance Group. Ann Surg 2015:261:1153-9.
7 Bakker et al. Surgery 2015;157:1130-6.
8 Simpson et al. Br J Anaesth 2015;115:560-8.
9 Francis et al. Colorectal Dis 2015;17:148-54.
10 Smart et al. Colorectal Dis 2012;14:727-34.
Patient Monitoring
Advanced monitoring requires highly precise measurement of change in cardiac function and haemodynamic status. (See the precision evidence table.)
ODM+ takes a highly precise measure of the velocity of red blood cells travelling down the descending thoracic aorta, 180 times per second. Thus, Doppler provides the ability to: