Intraoperative Fluid Management using the EDM+ is a vital element of Enhanced Recovery and has been well validated within the protocol. In the UK, it is supported by the Enhanced Recovery Partnership in line with the National Institute of Clinical Excellence (NICE) Guidance MTG3, the NHS Operating Framework 2014/15 and the Department of Health Innovation Health and Wealth Review 2011.
In Europe, the EDM was chosen by the Enhanced Recovery After Surgery (ERAS) group, identifying that ‘Esophageal Doppler ultrasonography was chosen as the preferred method of monitoring intraoperative stroke volume due to the broader evidence base in this context’.
The benefits of a comprehensive Enhanced Recovery program have been demonstrated in numerous specialties, including: Colorectal, endocrine, gynecological, urological, vascular and orthopedic surgeries.
Enhanced Recovery principles and protocols are now considered to be a standard of care in many surgical specialties with further studies also being carried out in: emergency surgery, AAA, esophago-gastric, lung, liver, pancreatic and cesarean sections.
This listing identifies the surgical patients who should receive EDM, as recommended by the Enhanced Recovery Partnership:
- Major surgery with a mortality rate of >1%.
- Major surgery with an anticipate blood loss of greater than 500mls.
- Major intra-abdominal surgery.
- Intermediate surgery in high-risk patients, including patients aged >80 years.
- Unexpected blood loss and/or fluid loss requiring >2 litres of fluid replacement.
- Patients with ongoing evidence of hypovolemia and/or tissue hypoperfusion.
Monty Mythen, Clinical Lead for the Department of Health’s Enhanced Recovery Partnership Program & Professor of Anaesthesia & Critical Care at University College London said:
“I have worked with EDM for almost two decades and have seen the benefits in my patients. By offering a much less invasive method of fluid management during and after surgery, EDM helps patients recover more quickly. I am delighted that this guidance has highlighted the advantages of this technology, and I hope that it gives the NHS the impetus it needs to ensure better access for all.” March 2011