Fluid Variation

Fluid Utilization

A large observational database study: 499 USA centers, 4-year duration.¹

1 Thacker et al. Perioperative Fluid Utilization Variability and Association With Outcomes. Ann Surg 2015;17:in press.

Variation in Fluid Utilization

Small studies have suggested variation in perioperative fluid delivery:^1,2

patient-to-patient
institution-to-institution

Questions exist regarding the impact of variation in fluid management across surgical practice.¹

Fluid optimization

“We should aspire to give patients just the right amount of fluid…if we do give them too much or too little, we believe that is associated with significant harm.”

Professor Michael Mythen

1 Lilot et al. Br J Anaesth 2015;114:767-76.
2 Minto and Mythen. Br J Anaesth 2015;114:717-21.

Key Findings

Wide patient-to-patient variation.¹

1 Thacker et al. Perioperative Fluid Utilization Variability and Association With Outcomes. Ann Surg 2015;17:in press.

Key Findings continued

Wide institution-to-institution variation – independant of variables.¹

1 Thacker et al. Perioperative Fluid Utilization Variability and Association With Outcomes. Ann Surg 2015;17:in press.

Variation Influences Outcome

In colon surgery, low and high fluid utilization were associated with higher odds of postoperative ileus, increased length of stay (LOS) and higher costs than those patients in the middle optimal zone.¹

Evaluation by type of surgery showed no statistical difference in mean fluid utilization for laparoscopy compared with traditional ‘open’ surgery. However, outcomes were statistically significantly worse for those patients receiving suboptimally low or high amounts of fluid.¹

1 Thacker et al. Perioperative Fluid Utilization Variability and Association With Outcomes. Ann Surg 2015;17:in press.

Advanced Monitoring

Fluid optimization would likely lead to decreased variability and improved outcomes.¹

Professor Michael ‘Monty’ Mythen, Anaesthesia and Critical Care, University College London comments on this research.

What are the key findings of the Perioperative Fluid Variation Study?

Why is this significant?

1 Thacker et al. Ann Surg 2015;17:in press.

Safety Matters

Fluid optimization has a role in safe practice.

Professor Michael ‘Monty’ Mythen, Anaesthesia and Critical Care, University College London comments on this research.¹

What should these results mean for clinical practice?

1 Thacker et al. Ann Surg 2015;17:in press.

Evidence-Based Fluid Management

There is extensive evidence to show the benefit of precise cardiac output measurement with esophageal Doppler monitoring in clinical trials.^1-4

Yet, compliance is an issue and concordance with enhanced recovery protocols in colorectal surgery has been shown to significantly reduce:

length of hospital stay^5-8
hospital readmission⁹

Furthermore, protocol deviation is predictive of delayed hospital discharge.¹⁰

1 Noblett et al. Br J Surg 2006;93:1069-76.
2 Wakeling et al. Br J Anaesth 2005;95:634-42.
3 Sinclair et al. BMJ 1997;315:909-12.
4 Gan et al. Anesthesiology 2002;97:820-6.
5 Rona et al. Am Surg 2012;78:1041-4.
6 ERAS Compliance Group. Ann Surg 2015:261:1153-9.
7 Bakker et al. Surgery 2015;157:1130-6.
8 Simpson et al. Br J Anaesth 2015;115:560-8.
9 Francis et al. Colorectal Dis 2015;17:148-54.
10 Smart et al. Colorectal Dis 2012;14:727-34.

Patient Monitoring

Advanced monitoring requires highly precise measurement of change in cardiac function and hemodynamic status. (See the precision evidence table.)

EDM+ takes a highly precise measure of the velocity of red blood cells travelling down the descending thoracic aorta, 180 times per second. Thus, Doppler provides the ability to:

Fluid Challenge

Simulator Use