Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery

Abstract

Intraoperative oesophageal Doppler guided fluid management was associated with a 1.5-day median reduction in postoperative hospital stay. Patients recovered gut function significantly faster and suffered significantly less gastrointestinal and overall morbidity.

Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS)

“…This should be given rapidly over five to ten minutes, 23 and although there is no consensus on the type of fluid given, most trials in the operating room showing an improved outcome were performed with a colloid. [24][25][26][27][28][29][30][31][32] Importantly, hemodynamic instability does not equate with volume responsiveness; indeed, only 50% of hemodynamically unstable patients in the operating room are ''volume responders''. 33 Moreover, volume responsiveness does not always mean that a fluid bolus is needed.…”

Inter-device differences in monitoring for goal-directed fluid therapy

“…The mean weighted average of these trials suggests a reduction of 3.7 days in hospital length of stay (LOS) ( Table 2). 25,[48][49][50][51][52][53] In addition to these randomized controlled trials, the United Kingdom's National Health Service Technology Adoption Centre conducted a case study of esophageal Doppler as part of its enhanced recovery effort. Based on the use of EDM in 649 patients undergoing major surgery at three hospitals (as compared with 658 matched patients who did not received EDM in the 12 months prior), the National Health Service (NHS) documented a 3.6-day reduction in hospital LOS.…”

Transesophageal Doppler devices: A technical review

“…Clinical studies comparing TED guided protocols to conventional approaches of volume replacement (guided by clinical assessment and/or central venous pressure) conclusively report beneficial effects in the Doppleroptimized groups, including a reduced risk of postoperative morbidity and a shorter length of hospital or ICU stay [11][12][13][14][15][16][17][18][19]. In addition to fluid optimization, other clinical applications such as early detection of hemodynamic changes associated with transurethral resection syndrome have also been reported [95].…”

“…However, up to now data to support its usefulness in guiding inotopic or vasoactive therapy in such patients is limited and the potential of TED to replace more invasive techniques in critical care units needs to be further determined. In contrast, the role of TED in optimizing perioperative volume replacement has been well characterized [11][12][13][14][15][16][17][18][19]. TED allows assessment of fluid responsiveness by monitoring changes in stroke volume secondary to fluid challenges, allowing individual titration of fluids to maximize CO while avoiding excessive fluid loading.…”

“…A major advantage of TED is that it allows extended monitoring and facilitates hemodynamic optimization in patients in whom advanced hemodynamic parameters such as CO would otherwise not be monitored. Compared to conventional clinical assessment, fluid management guided by TED to optimize stroke volume has been shown to improve patient outcome and to reduce the length of hospital stay [10][11][12][13][14][15][16][17][18][19], suggesting that this technique can be a valuable supplement to current standard hemodynamic monitoring.…”