Only EDM+ has the Precision, concludes new Study
Direct comparison between three monitoring technologies says only EDM+ picks up outcome-determining hemodynamic changes.
We’ve covered the RELIEF study on our news pages before, here. The paper, from Myles et al, was published in 2018 in the New England Journal of Medicine and can be found here. Now a new study into the RELIEF data has revealed even more compelling clinical implications.
The RELIEF study compared restrictive and liberal intravenous fluid regimens during surgery and the subsequent 24-hours. Patients in the restrictive fluid group had a significantly higher incidence of acute kidney injury (AKI) than those in the liberal fluid group. This was striking because many had hitherto seen a restrictive regimen as a key tenet of an Enhanced Recovery After Surgery (ERAS) protocol.
Indeed lead author Dr. Paul Myles is now calling for a change to the guidance for ERAS protocols. Listen to him discuss ‘Restricted’ versus ‘Moderate Liberal’ fluid regimens on TopMedTalk here.
In the newly published study, Phan et al dug a little deeper into a subset of the original RELIEF data. It has now been published in the BJA here.
The majority of patients in RELIEF had no form of hemodynamic monitoring. However a small group of 109 patients did and it was these patients who were analyzed.
The hemodynamic monitoring techniques utilized on these patients were the Esophageal Doppler(EDM), Pulse Pressure Waveform Analysis (PPWA) and Plethysmography(PVI). Specifically, the investigators compared Stroke Volume(SV) and Cardiac Index(CI) data using the EDM and PPWA monitoring methodologies as well as PVI. In effect they asked whether the type of monitoring employed had identified the hemodynamic factors that dictate the known likelihood of fluid-related complications.
Not all Hemodynamic Monitors spot AKI risk parameters, but EDM does.
The findings provide powerful reinforcement for the monitoring accuracy of EDM. In this data set the EDM system identified significantly different SV and CI data from the restrictive and liberal groups. PPWA and PVI failed to do so. As the study says; “Arterial-pressure-based stroke volume and cardiac index did not differ, nor was there a significant difference in stroke volume variation, pulse pressure variation, or plethysmographic variability index.”
This of course provides reassurance for EDM+ users. The system’s renowned accuracy was singularly able to detect changes in hemodynamic status that the RELIEF study tells us yield differences in outcome.
Avoiding the Avoidable means using EDM+
Deltex Medical CEO, Andy Mears states; “Once more we see the power of EDM+. The system clearly measures Stroke Volume and Cardiac Index at a level of accuracy the other systems cannot. This matters because the RELIEF study concluded that one hemodynamic regimen resulted in higher AKI than the other. Only EDM+ is accurate enough to spot the difference.”