Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures † †These findings were presented in part at the 13th Annual Meeting of the European Society of Intensive Care Medicine, Rome 2000.

Abstract

Invasive intraoperative haemodynamic monitoring with fluid challenges during repair of femoral fracture under general anaesthetic shortens time to being medically fit for discharge.

3.5% urea-linked gelatin is as effective as 6% HES 200/0.5 for volume management in cardiac surgery patients

“…[1][2][3] In patients undergoing cardiac surgery, maximizing cardiac output through titrated perioperative volume expansion was associated with a lower postoperative morbidity and a reduced length of stay in the intensive care unit (ICU) and in the hospital. 4 In addition, regional tissue perfusion was better maintained as demonstrated by a lower incidence of gut mucosal hypoperfusion in the study group.…”

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.…”

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.…”