title: Conventional monitoring and intravascular volume measurement can lead to different therapy after upper gastrointestinal tract surgery.
abstract: OBJECTIVE
  The purpose of this study was to compare the judgment of intravascular volume based either on conventional monitoring or on the data of COLD measurement.
  
  
  METHODS
  Single-blinded, observational study.
  
  
  METHODS
  Intensive care unit (ICU).
  
  
  METHODS
  Ten consecutive patients after upper gastrointestinal tract surgery for carcinoma.
  
  
  RESULTS
  Judgments ( n=59) about intravascular volume (hypo-, iso- or hypervolemic) were given twice a day until the 2nd postoperative day by two physicians. Physician A's judgment was based on conventional monitoring and physician B's judgment on COLD monitoring. Both were blinded for each other's judgment. The inter-rater agreement between A and B was analyzed using the weighted kappa statistic. Both physicians gave a recommendation about the volume therapy during the following 12 h. The therapeutic regimen, including volume therapy, was defined by physician A. The inter-rater-agreement regarding intravascular volume was poor (overall weighted kappa =0.095). The sum of absolute differences between A and B in their recommendation about infusion administration reached a median of 4,875 ml per patient.
  
  
  CONCLUSIONS
  The poor inter-rater agreement between the two physicians and the consecutive difference in the infusion therapy may have clinical consequences and should be evaluated in further studies. These data cannot confirm which decision strategy should be preferred.
authors.affiliation: Department of General, Visceral, Vascular and Thoracic Surgery, Charité Campus Mitte, Humboldt University, Campus Charité Mitte, Schumanstrasse 20/21, 10117 Berlin, Germany. tido.junghans@charite.de
authors.forename: Tido
authors.initials: T
authors.lastname: Junghans
authors.forename: Bartholomäus
authors.initials: B
authors.lastname: Böhm
authors.forename: Oliver
authors.initials: O
authors.lastname: Haase
authors.forename: Johannes
authors.initials: J
authors.lastname: Fritzmann
authors.forename: Heidrun
authors.initials: H
authors.lastname: Zuckermann-Becker
mesh_terms: D000368:Aged; D001810:Blood Volume; D003422:Critical Care; D004938:Esophageal Neoplasms / Q000601:surgery*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011182:Postoperative Care; D013815:Thermodilution