TopMedTalk Journal Review of FEDORA study

- 20 April, 2018

The BJA recently published the FEDORA RCT of 420 patients. The study’s statistically significant results reinforce the UK’s NICE recommendation to use oesophageal Doppler monitor (ODM).

Now, TopMedTalk, disseminator of medical news, has reviewed the paper in its Journal Club, hosted by Professor Monty Mythen of UCL, London.

You can listen to the review here, or enjoy some highlights, as follows:

A multicentre, randomised controlled study, FEDORA concluded that:

Haemodynamic Optimisation significantly reduced post-op complications and length of stay in low to moderate risk patients undergoing major abdominal surgery
Goal-Directed Haemodynamic Therapy is beneficial even in low to moderate risk patients.

Prof Mythen points out that the Cochrane collaboration has identified 70 prospective, randomised controlled trials on this subject. Moreover, every time meta-analysis has been performed, the result is broadly the same.

The FEDORA study “reinforces what the meta-analyses told us to expect.”

Prof Mythen goes on to point out the distinction between Goal-Directed Fluid Therapy (GDFT) and Goal Directed Haemodynamic Therapy (GDHT). GDHT implies a more all-encompassing management of the parameters than could be achieved by focusing on fluid alone.

FEDORA is an Oesophageal Doppler trial, asking whether ODM can be used to improve outcomes in low to moderate risk patients. The review reminds us that the benefit of ODM is that it is a precision tool that measures flow velocity directly from the descending aorta. In other words, unlike other technologies, Doppler monitoring “is not deriving anything.”

Prof Mythen goes on to say that, “everyone accepts the fact that it is the most precise tool – while others that may have greater utility or user friendliness are wannabe technologies.”

Deltex Managing Director Andy Mears states; “FEDORA is a landmark study: It is the first RCT showing outcome benefit in patients having low to moderate abdominal surgery using a GDHT protocol that is only achievable using the ODM. We’re grateful to the clinicians involved for delivering such a complete study, and to Prof Mythen for such a comprehensive review on TopMedTalk.”