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Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery.
Br J Anaesth. 2012 Jan; 108(1):53-62.BJ

Abstract

BACKGROUND

Intraoperative fluid therapy regimens using oesophageal Doppler monitoring (ODM) to optimize stroke volume (SV) (goal-directed fluid therapy, GDT) have been associated with a reduction in length of stay (LOS) and complication rates after major surgery. We hypothesized that intraoperative GDT would reduce the time to surgical readiness for discharge (RfD) of patients having major elective colorectal surgery but that this effect might be less marked in aerobically fit patients.

METHODS

In this double-blinded controlled trial, 179 patients undergoing major open or laparoscopic colorectal surgery were characterized as aerobically 'fit' (n=123) or 'unfit' (n=56) on the basis of their performance during a cardiopulmonary exercise test. Within these fitness strata, patients were randomized to receive a standard fluid regimen with or without ODM-guided intraoperative GDT.

RESULTS

GDT patients received an average of 1360 ml of additional intraoperative colloid. The mean cardiac index and SV at skin closure were significantly higher in the GDT group than in controls. Times to RfD and LOS were longer in GDT than control patients but did not reach statistical significance (median 6.8 vs 4.9 days, P=0.09, and median 8.8 vs 6.7 days, P=0.09, respectively). Fit GDT patients had an increased RfD (median 7.0 vs 4.7 days; P=0.01) and LOS (median 8.8 vs 6.0 days; P=0.01) compared with controls.

CONCLUSIONS

Intraoperative SV optimization conferred no additional benefit over standard fluid therapy. In an aerobically fit subgroup of patients, GDT was associated with detrimental effects on the primary outcome.

TRIAL REGISTRY

UK NIHR CRN 7285, ISRCTN 14680495. http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=7285.

Authors+Show Affiliations

Directorate of Gastroenterology, Theatres and Pain, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth PL6 8DH, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21873370

Citation

Challand, C, et al. "Randomized Controlled Trial of Intraoperative Goal-directed Fluid Therapy in Aerobically Fit and Unfit Patients Having Major Colorectal Surgery." British Journal of Anaesthesia, vol. 108, no. 1, 2012, pp. 53-62.
Challand C, Struthers R, Sneyd JR, et al. Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery. Br J Anaesth. 2012;108(1):53-62.
Challand, C., Struthers, R., Sneyd, J. R., Erasmus, P. D., Mellor, N., Hosie, K. B., & Minto, G. (2012). Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery. British Journal of Anaesthesia, 108(1), 53-62. https://doi.org/10.1093/bja/aer273
Challand C, et al. Randomized Controlled Trial of Intraoperative Goal-directed Fluid Therapy in Aerobically Fit and Unfit Patients Having Major Colorectal Surgery. Br J Anaesth. 2012;108(1):53-62. PubMed PMID: 21873370.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery. AU - Challand,C, AU - Struthers,R, AU - Sneyd,J R, AU - Erasmus,P D, AU - Mellor,N, AU - Hosie,K B, AU - Minto,G, Y1 - 2011/08/26/ PY - 2011/8/30/entrez PY - 2011/8/30/pubmed PY - 2012/1/24/medline SP - 53 EP - 62 JF - British journal of anaesthesia JO - Br J Anaesth VL - 108 IS - 1 N2 - BACKGROUND: Intraoperative fluid therapy regimens using oesophageal Doppler monitoring (ODM) to optimize stroke volume (SV) (goal-directed fluid therapy, GDT) have been associated with a reduction in length of stay (LOS) and complication rates after major surgery. We hypothesized that intraoperative GDT would reduce the time to surgical readiness for discharge (RfD) of patients having major elective colorectal surgery but that this effect might be less marked in aerobically fit patients. METHODS: In this double-blinded controlled trial, 179 patients undergoing major open or laparoscopic colorectal surgery were characterized as aerobically 'fit' (n=123) or 'unfit' (n=56) on the basis of their performance during a cardiopulmonary exercise test. Within these fitness strata, patients were randomized to receive a standard fluid regimen with or without ODM-guided intraoperative GDT. RESULTS: GDT patients received an average of 1360 ml of additional intraoperative colloid. The mean cardiac index and SV at skin closure were significantly higher in the GDT group than in controls. Times to RfD and LOS were longer in GDT than control patients but did not reach statistical significance (median 6.8 vs 4.9 days, P=0.09, and median 8.8 vs 6.7 days, P=0.09, respectively). Fit GDT patients had an increased RfD (median 7.0 vs 4.7 days; P=0.01) and LOS (median 8.8 vs 6.0 days; P=0.01) compared with controls. CONCLUSIONS: Intraoperative SV optimization conferred no additional benefit over standard fluid therapy. In an aerobically fit subgroup of patients, GDT was associated with detrimental effects on the primary outcome. TRIAL REGISTRY: UK NIHR CRN 7285, ISRCTN 14680495. http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=7285. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/21873370/Randomized_controlled_trial_of_intraoperative_goal_directed_fluid_therapy_in_aerobically_fit_and_unfit_patients_having_major_colorectal_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)32515-1 DB - PRIME DP - Unbound Medicine ER -