Doppler-guided intra-operative fluid management during major abdominal surgery: systematic review and meta-analysis.
BACKGROUND
Peri-operative fluid therapy is a controversial area with few randomised trials to guide practice. Recently, a number of trials have suggested that intra-operative therapy guided by oesophageal Doppler acquired haemodynamic variables may improve postoperative outcome.


METHODS
Abstract databases and conference proceedings were searched to identify randomised controlled trials comparing Doppler-guided intra-operative fluid management to standard practice in patients undergoing major abdominal surgery. Pooled odds ratios (POR) and weighted mean differences (WMD) were calculated for categorical and continuous outcomes respectively.


RESULTS
Four trials, comprising 393 patients, were identified. Use of an oesophageal Doppler-guided fluid management algorithm resulted in fewer postoperative complications (POR 0.32; 95% CI: 0.19-0.52; p < 0.0001) and shorter hospital stays (WMD 1.68 days; 95% CI: 2.39-0.98; p < 0.0001). There were no significant differences in the quantities of intra-operative fluids administered although there was some evidence of heterogeneity with respect to this outcome.


CONCLUSIONS
Oesophageal Doppler-guided fluid management may improve outcome following major intra-abdominal surgery. However, comparison with fluid restriction strategies, including a cost-effectiveness analysis are required.
Walsh
S R
SR
Department of General Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. srwalsh@doctors.org.uk
Tang
T
T
Bass
S
S
Gaunt
M E
ME
D000005:Abdomen / Q000000981:diagnostic imaging / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*