NICE guidance on CardioQTM oesophageal Doppler monitoring

NICE guidance on CardioQ™

“…The accidental omission of some of the authors' competing interests and the subsequent Corrigendum [1] relating to the Difficult Airway Society's (DAS's) 'ADEPT' guidance on selecting and evaluating airway devices [2] raise several important questions.…”

“…We would also encourage clinical experts to respond to public consultation, which is a very influential step in the production of NICE guidance. in particular the evidence on which this guidance was based [1]. Our greatest concern was that this guidance, which was intended to make the case for adoption of the product, seemed to be based on a small number of randomised trials each containing only a small number of patients, a point reiterated by Minto et al [2].…”

“…As the authors of that trial point out, this may be simply because their standard fluid regimen resulted in higher cardiac outputs in their control group than in previous studies that did demonstrate benefit. We noted in our editorial that the difference between controls and study groups in the trials considered by NICE amounted to a small bag of fluid per patient [1], and this latest trial bears out the fact that a less conservative approach to fluid management during major surgery may yield the same beneficial results with or without the CardioQ. The process by which NICE develops such guidance has been well described by Campbell et al [5], however they fail to make the point that every NICE guidance is given a great deal of weight by hospital managers, to the extent that pressure is placed on clinicians to justify why they choose not to adopt such guidance.…”

Oesophageal Doppler monitoring: premature guidance and what about the fluids?

“…We would like to thank the authors of the editorial published in December's Anaesthesia [1] highlighting the quality of evidence used in the National Institute for Health and Clinical Excellence (NICE) guidance on oesophageal Doppler monitoring (ODM).…”

“…Ghosh, Arthur and Klein are to be congratulated for their critical analysis of the evidence presented to the National Institute for Health and Clinical Excellence (NICE) about oesophageal Doppler monitoring (ODM) [1]. I share their view that it may have been premature to recommend this particular monitor before its competitors.…”