title: Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery.
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.
authors.affiliation: Department of Anaesthesia, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK. howard.wakeling@wash.nhs.uk
authors.forename: H G
authors.initials: HG
authors.lastname: Wakeling
authors.forename: M R
authors.initials: MR
authors.lastname: McFall
authors.forename: C S
authors.initials: CS
authors.lastname: Jenkins
authors.forename: W G A
authors.initials: WG
authors.lastname: Woods
authors.forename: W F A
authors.initials: WF
authors.lastname: Miles
authors.forename: G R
authors.initials: GR
authors.lastname: Barclay
authors.forename: S C
authors.initials: SC
authors.lastname: Fleming
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D002496:Central Venous Pressure; D004311:Double-Blind Method; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D020896:Hypovolemia / Q000000981:diagnostic imaging / Q000517:prevention & control*; D007420:Intestine, Large / Q000503:physiopathology / Q000601:surgery*; D007430:Intraoperative Care / Q000379:methods*; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D011446:Prospective Studies; D020127:Recovery of Function; D013318:Stroke Volume