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. Issue 6 (November 2014)

• Record Type: Journal Article
• Authors: Phan, T. D.; An, V.; D'Souza, B.; Rattray, M. J.; Johnston, M. J.; Cowie, B. S.
• Is Part Of: Anaesthesia and intensive care. Volume 42:Issue 6(2014)
• Page Start: 752
• Page End: 760
• Publication Date: 2014-11
• Subjects: fluid therapy -- cardiac output -- Doppler -- colorectal surgery -- postoperative complications -- monitoring – intra-operative; Anesthesiology -- Periodicals; Intensive Care Units -- Periodicals; 617.96
• DOI: 10.1177/0310057X1404200611
• Languages: English
• ISSNs: 0310-057X

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. One hundred patients, 50 in each group, were included in the analysis. 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, P =0.421. The number of patients with any complication (minor or major) was similar; 60% (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.