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Efficacy of intraoperatory optimisation of fluids guided with transoesophageal doppler monitorisation: a multicentre randomised controlled trial: 1AP3‐10

Vecino, Calvo J.M.1; Melchor, Ripollés J.1; Hurtado, Martínez E.1; Gurumeta, Abad A.2; Francés, Casáns R.3; Serrano, A.4

European Journal of Anaesthesiology: June 2014 - Volume 31 - Issue - p 13
Evidence-based Practice and Quality Improvement

1Hospital Universitario Infanta Leonor, Dept of Anaesthesiology & Intensive Care, Madrid, Spain, 2Hospital Universitario La Paz, Dept of Anaesthesiology & Intensive Care, Madrid, Spain, 3Hospital Clínico Universitario Lozano Blesa, Dept of Anaesthesiology, Zaragoza, Spain, 4Hospital Universitario Ramón y

Cajalón y Cajal, Dept of Anaesthesiology & Intensive Care, Madrid, Spain

Background and Goal of Study: Several single‐center studies and metaanalyses have shown that perioperative goal‐directed therapy may significantly improve outcomes in abdominal major surgical patients. The main objective of the study was to compare the stay among surgical patients monitored with oesophageal doppler versus unmonitored patients, into a protocol of restrictive goal‐directed fluid therapy (based on CI=2.5 achieved by SV control). We hypothesized that using a treatment algorithm based on ODM parameters variation, in a study group, would result in reduced complications, reduced length of hospital stay and quicker return of bowel movement postoperatively in abdominal surgical patients, when compared to a control group.

Materials and Methods: The study design is a randomized multicenter clinical trial on patients Treated conducted in Spain from July 2012. We present preliminary results regarding hospital stay and critical care units stay. Surgeries were for general surgery, urology, gynecology and orthopedic surgery specialties. ISRCTN93543537.

Results and Discussion: 121 patients were studied. There were no statistically significant differences in any of the baseline variables recorded. We can point out that randomization worked and the intervention and control groups were homogeneous in their baseline characteristics.

59.1% of the patients were men. Mean age of patients was 65.80 years. According to the surgical specialty 63.4% belonged to the general surgery group, 10.2% of gynecological surgery, 24.72% of urologic surgery and 1,68% of orthopedic surgery. According to the surgical technique were 28.5% open surgeries and 71.5% were laparoscopic.

The results were favorable to the intervention group for the outcome variables, total stay, postoperative critical care unit stay (ICU stay), oral tolerance time and walking time. We emphasize the difference in postoperative stay in ICU of 1.73 days less (p= 0,000) and total stay of 1,76 days less (p= 0,010).

Conclusion(s): Results obtained in a primary outcome, postsurgical length of stay, as in most of the rest of outcomes were favorable to monitoring by esophageal doppler. Final analysis of the trial will permit us to obtain conclusions about the use of this device in a perioperative restrictive protocol of goal‐directed therapy.

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References:

Salzwedel et al. Critical Care 2013, 17:R191
S. Srinivasa et al. British Journal of Surgery 2013; 100: 1701-1708
© 2014 European Society of Anaesthesiology