Systematic review of the clinical effectiveness and cost-effectiveness of oesophageal Doppler monitoring in critically ill and high-risk surgical patients.

Abstract

More formal economic evaluation would allow better use of the available data. All identified studies were conducted in unconscious patients. However, further research is needed to evaluate new ODM probes that may be tolerated by awake patients. Given the paucity of the existing economic evidence base, any further primary research should include an economic evaluation or should provide data suitable for use in an economic model.

NICE guidance on CardioQTM oesophageal Doppler monitoring

“…In addition, NICE gave some consideration to an audit [10] of a mixture of major surgical procedures that included 626 patients in whom the CardioQ was used. Two meta-analyses of data drawn principally from the same clinical trials were also taken into account [11,12].…”

Stroke Volume Optimization: The New Hemodynamic Algorithm

“…Until more randomized trials on the impact of SVO protocols on the outcomes of critical care patients are published, SVO is supported by more evidence than is use of filling pressures for fluid replacement in critical care units. 27,32,[44][45][46][47][48][49][50][51][52]73,74,[86][87][88] On the basis of our review of the current available literature, we suggest that the SVO algorithm for fluid replacement be considered in place of use of cardiac filling pressures for patients in critical care, as appropriate, with attention to outcomes. In the meantime, more research is needed to evaluate the impact of SVO on patients other than perioperative patients and on nonintubated patients.…”

“…Although 2 of these trials 44,47 also focused on postoperative care in the critical care unit, more research is needed to indicate the efficacy of SVO in nonsurgical patients. However, in perioperative patients, the strength of the supporting evidence in favor of SVO has been substantiated by large-scale systematic literature reviews conducted by the Agency for Healthcare Research and Quality, 87 the National Health Service, 86 and third-party payers such as the Centers for Medicare and Medicaid Services 88 and Aetna. 89 In 3 of these studies, [86][87][88] the agencies recommended SVO protocols be used for monitoring cardiac output of patients receiving mechanical ventilation in the critical care unit and for surgical patients who require intraoperative fluid optimization.…”

“…However, in perioperative patients, the strength of the supporting evidence in favor of SVO has been substantiated by large-scale systematic literature reviews conducted by the Agency for Healthcare Research and Quality, 87 the National Health Service, 86 and third-party payers such as the Centers for Medicare and Medicaid Services 88 and Aetna. 89 In 3 of these studies, [86][87][88] the agencies recommended SVO protocols be used for monitoring cardiac output of patients receiving mechanical ventilation in the critical care unit and for surgical patients who require intraoperative fluid optimization. Esophageal Doppler imaging, 88 bioimpedance, 90 and PACs 91 are all reimbursed by the Centers for Medicare and Medicaid Services 88 on the basis of systematic literature reviews.…”

“…Appropriately implemented SVO programs that replicate these outcomes may also be associated with decreased costs. 86 Notably, the sample in all 11 trials [44][45][46][47][48][49][50][51][52]73,74 included perioperative patients. Although 2 of these trials 44,47 also focused on postoperative care in the critical care unit, more research is needed to indicate the efficacy of SVO in nonsurgical patients.…”