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Studies Overlap to Confirm Haemodynamic Therapy is All About Timing

Two recent major studies, tagged FEDORA (BJA) and RELIEF (NEJM) powerfully combine to tell us so much about the importance of maintaining control over fluid balance in the anaesthetised surgical patient. In the RELIEF study a restrictive fluid regime is associated with worse outcomes, yielding a higher incidence of Acute Kidney Injury(AKI) and Surgical Site Infections (SSIs) than when more liberal fluid protocols are adopted.

Overlay the FEDORA data from low to moderate risk major surgery patients and the view is even clearer. FEDORA tells us it’s not just about the amount of fluid, it’s also about the timing, as dictated by a Goal Directed Haemodynamic Therapy (GDHT) approach. GDHT utilising the Oesophageal Doppler (ODM) technology keeps the patient in a haemodynamic safe zone. In doing so, the evidence says post-op complications are significantly (and dramatically) reduced.

Strikingly, reviewing FEDORA and RELIEF data shows that ODM treated patients generally received less fluid than fixed regimes (restrictive group in RELIEF) and still have much better outcomes. It’s hard not to conclude that fluid, whether given liberally or restricted, is a blunt instrument. Best results as measured by avoidance of complications and length of stay, are delivered when the amount and timing of fluid application is guided by the patient’s own haemodynamic status, which can only be accurately be determined from direct cardiac output monitoring using oesophageal Doppler (ODM+ with TrueVue technology).