As part of their review of esophageal Doppler guided fluid management, CMS commissioned a technology assessment from the Agency for Healthcare Research and Quality (AHRQ). The technology assessment, published in March 2007, reviewed some 317 articles, including seven independently conducted, randomized controlled trials.
The technology assessment process grades the quality of evidence for a given technology as being ‘strong’, ‘moderate’, ‘weak’ or ‘inconclusive’. Strong evidence is defined as “evidence supporting the qualitative conclusion is convincing. It is highly unlikely that new evidence will lead to a change in this conclusion”.
The technology assessment for EDM concluded that in “patients undergoing surgical procedures with an expected substantial blood loss or fluid compartment shifts requiring fluid replacement” the clinical evidence for EDM was strong in respect of the following three statements:
- “Doppler-guided fluid replacement during surgery leads to a clinically significant reduction in major complications”;
- “Doppler-guided fluid replacement during surgery leads to a clinically significant reduction in the total number of complications”; and
- “Doppler-monitored fluid replacement leads to a reduction in hospital stay”.