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A randomised controlled trial of fluid restriction compared to oesophageal Doppler-guided goal-directed fluid therapy in elective major colorectal surgery within an Enhanced Recovery After Surgery program.
Anaesth Intensive Care. 2014 Nov; 42(6):752-60.AI

Abstract

There is continued controversy regarding the benefits of goal-directed fluid therapy, with earlier studies showing marked improvement in morbidity and length-of-stay that have not been replicated more recently. The aim of this study was to compare patient outcomes in elective colorectal surgery patients having goal-directed versus restrictive fluid therapy. Inclusion criteria included suitability for an Enhanced Recovery After Surgery care pathway and patients with an American Society of Anesthesiologists Physical Status score of 1 to 3. Patients were intraoperatively randomised to either restrictive or Doppler-guided goal-directed fluid therapy. The primary outcome was length-of-stay; secondary outcomes included complication rate, change in haemodynamic variables and fluid volumes. Compared to restrictive therapy, goal-directed therapy resulted in a greater volume of intraoperative fluid, 2115 (interquartile range 1350 to 2560) ml versus 1500 (1200 to 2000) ml, P=0.008, and was associated with an increase in Doppler-derived stroke volume index from beginning to end of surgery, 43.7 (16.3) to 54.2 (21.1) ml/m(2), P <0.001, in the latter group. Length-of-stay was similar, 6.5 (5 to 9) versus 6 (4 to 9) days, P=0.421. The number of patients with any complication (minor or major) was similar; 0% (30) versus 52% (26), P=0.42, or major complications, 1 (2%) versus 4 (8%), P=0.36, respectively. The increased perioperative fluid volumes and increased stroke volumes at the end of surgery in patients receiving goal-directed therapy did not translate to a significant difference in length-of-stay and we did not observe a difference in the number of patients experiencing minor or major complications.

Authors+Show Affiliations

Department of Anaesthesia, University of Melbourne and St Vincent's Hospital, Melbourne, Victoria.Department of Colorectal Surgery, St Vincent's Hospital, Fitzroy, Victoria.Department of Anaesthesia, University of Melbourne and St Vincent's Hospital, Melbourne, Victoria.Department of Colorectal Surgery, St Vincent's Hospital, Fitzroy, Victoria.Department of Anaesthesia, University of Melbourne and St Vincent's Hospital, Melbourne, Victoria.

Pub Type(s)

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

Language

eng

PubMed ID

25342408

Citation

Phan, T D., et al. "A Randomised Controlled Trial of Fluid Restriction Compared to Oesophageal Doppler-guided Goal-directed Fluid Therapy in Elective Major Colorectal Surgery Within an Enhanced Recovery After Surgery Program." Anaesthesia and Intensive Care, vol. 42, no. 6, 2014, pp. 752-60.
Phan TD, D'Souza B, Rattray MJ, et al. A randomised controlled trial of fluid restriction compared to oesophageal Doppler-guided goal-directed fluid therapy in elective major colorectal surgery within an Enhanced Recovery After Surgery program. Anaesth Intensive Care. 2014;42(6):752-60.
Phan, T. D., D'Souza, B., Rattray, M. J., Johnston, M. J., & Cowie, B. S. (2014). A randomised controlled trial of fluid restriction compared to oesophageal Doppler-guided goal-directed fluid therapy in elective major colorectal surgery within an Enhanced Recovery After Surgery program. Anaesthesia and Intensive Care, 42(6), 752-60.
Phan TD, et al. A Randomised Controlled Trial of Fluid Restriction Compared to Oesophageal Doppler-guided Goal-directed Fluid Therapy in Elective Major Colorectal Surgery Within an Enhanced Recovery After Surgery Program. Anaesth Intensive Care. 2014;42(6):752-60. PubMed PMID: 25342408.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomised controlled trial of fluid restriction compared to oesophageal Doppler-guided goal-directed fluid therapy in elective major colorectal surgery within an Enhanced Recovery After Surgery program. AU - Phan,T D, AU - D'Souza,B, AU - Rattray,M J, AU - Johnston,M J, AU - Cowie,B S, PY - 2014/10/25/entrez PY - 2014/10/25/pubmed PY - 2014/12/19/medline KW - Doppler KW - cardiac output KW - colorectal surgery KW - fluid therapy KW - monitoring – intraoperative KW - postoperative complications SP - 752 EP - 60 JF - Anaesthesia and intensive care JO - Anaesth Intensive Care VL - 42 IS - 6 N2 - There is continued controversy regarding the benefits of goal-directed fluid therapy, with earlier studies showing marked improvement in morbidity and length-of-stay that have not been replicated more recently. The aim of this study was to compare patient outcomes in elective colorectal surgery patients having goal-directed versus restrictive fluid therapy. Inclusion criteria included suitability for an Enhanced Recovery After Surgery care pathway and patients with an American Society of Anesthesiologists Physical Status score of 1 to 3. Patients were intraoperatively randomised to either restrictive or Doppler-guided goal-directed fluid therapy. The primary outcome was length-of-stay; secondary outcomes included complication rate, change in haemodynamic variables and fluid volumes. Compared to restrictive therapy, goal-directed therapy resulted in a greater volume of intraoperative fluid, 2115 (interquartile range 1350 to 2560) ml versus 1500 (1200 to 2000) ml, P=0.008, and was associated with an increase in Doppler-derived stroke volume index from beginning to end of surgery, 43.7 (16.3) to 54.2 (21.1) ml/m(2), P <0.001, in the latter group. Length-of-stay was similar, 6.5 (5 to 9) versus 6 (4 to 9) days, P=0.421. The number of patients with any complication (minor or major) was similar; 0% (30) versus 52% (26), P=0.42, or major complications, 1 (2%) versus 4 (8%), P=0.36, respectively. The increased perioperative fluid volumes and increased stroke volumes at the end of surgery in patients receiving goal-directed therapy did not translate to a significant difference in length-of-stay and we did not observe a difference in the number of patients experiencing minor or major complications. SN - 0310-057X UR - https://www.unboundmedicine.com/medline/citation/25342408/A_randomised_controlled_trial_of_fluid_restriction_compared_to_oesophageal_Doppler_guided_goal_directed_fluid_therapy_in_elective_major_colorectal_surgery_within_an_Enhanced_Recovery_After_Surgery_program_ L2 - http://journals.sagepub.com/doi/full/10.1177/0310057X1404200611?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -