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BJA Advance Access published online on September 9, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei223
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oxfordjournals.org
Accepted July 8, 2005

Clinical Investigation

Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery

H. G. Wakeling 1*, M. R. McFall 1, C. S. Jenkins 1, W. G. A. Woods 2, W. F. A. Miles 2, G. R. Barclay 3, and S. C. Fleming 4

1 Department of Anaesthesia, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK
2 Department of Colorectal Surgery, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK
3 Department of Cell Therapy, Western General Hospital, Edinburgh, UK
4 Department of Clinical Chemistry, Royal Cornwall Hospitals NHS Trust, Cornwall, UK

* To whom correspondence should be addressed.
H. G. Wakeling, E-mail: howard.wakeling{at}wash.nhs.uk


  Abstract

Background. Occult hypovolaemia is a key factor in the aetiology of postoperative morbidity and may not be detected by routine heart rate and arterial pressure measurements. Intraoperative gut hypoperfusion during major surgery is associated with increased morbidity and postoperative hospital stay. We assessed whether using intraoperative oesophageal Doppler guided fluid management to minimize hypovolaemia would reduce postoperative hospital stay and the time before return of gut function after colorectal surgery.

Methods. This single centre, blinded, prospective controlled trial randomized 128 consecutive consenting patients undergoing colorectal resection to oesophageal Doppler guided or central venous pressure (CVP)-based (conventional) intraoperative fluid management. The intervention group patients followed a dynamic oesophageal Doppler guided fluid protocol whereas control patients were managed using routine cardiovascular monitoring aiming for a CVP between 12 and 15 mm Hg.

Results. The median postoperative stay in the Doppler guided fluid group was 10 vs 11.5 days in the control group P<0.05. The median time to resuming full diet in the Doppler guided fluid group was 6 vs 7 for controls P<0.001. Doppler patients achieved significantly higher cardiac output, stroke volume, and oxygen delivery. Twenty-nine (45.3%) control patients suffered gastrointestinal morbidity compared with nine (14.1%) in the Doppler guided fluid group P<0.001, overall morbidity was also significantly higher in the control group P=0.05.

Conclusions. Intraoperative oesophageal Doppler guided fluid management was associated with a 1.5-day median reduction in postoperative hospital stay. Patients recovered gut function significantly faster and suffered significantly less gastrointestinal and overall morbidity.

Keywords: complications, hypovolaemia; fluid balance; measurement techniques, transoesophageal Doppler; patient outcome.
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