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

Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine

“…-Using Oesophagus Doppler to measure stroke volume. This has been recommended by the National Institute for Health and Clinical Excellence (NICE) [147] and has been vigorously criticised and discussed since its introduction [148][149][150][151][152][153][154][155][156].…”

NICE guidance on CardioQ™

“…This places the onus on NICE to restrict issuing guidance on technologies to those for which the evidence is deemed to be of high quality, as well as with sufficient depth and breadth of supporting opinion. Our contention is that this is not the case for the CardioQ, especially as use of the device and the subsequent intravascular volume loading it may trigger is contentious in itself, as has also been pointed out by Woodcock [7]. In addition, we agree with Ghuman et al [8], that advocating a single device for measuring haemodynamic data over other devices, which is inherent in the publishing of such technology guidance, is not merited when there isn't conclusive evidence of superior benefit.…”

Oesophageal Doppler monitoring, doubt and equipoise: evidence based medicine means change

“…Based around a largely non‐clinical surrogate endpoint (length of stay), with inconsistent benefits on other complications, the evidence base is familiar to most readers and has been presented elsewhere . However individuals choose to interpret the available evidence, as a specialty we are still wrestling with the true meaning of the same data . Furthermore, formal cost analysis has not been undertaken to support NICE's suggestion of saving > £1100 per patient, which has got medical managers in quite a flutter .…”