title: Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery.
abstract: BACKGROUND
  Intraoperative fluid therapy regimens using oesophageal Doppler monitoring (ODM) to optimize stroke volume (SV) (goal-directed fluid therapy, GDT) have been associated with a reduction in length of stay (LOS) and complication rates after major surgery. We hypothesized that intraoperative GDT would reduce the time to surgical readiness for discharge (RfD) of patients having major elective colorectal surgery but that this effect might be less marked in aerobically fit patients.
  
  
  METHODS
  In this double-blinded controlled trial, 179 patients undergoing major open or laparoscopic colorectal surgery were characterized as aerobically 'fit' (n=123) or 'unfit' (n=56) on the basis of their performance during a cardiopulmonary exercise test. Within these fitness strata, patients were randomized to receive a standard fluid regimen with or without ODM-guided intraoperative GDT.
  
  
  RESULTS
  GDT patients received an average of 1360 ml of additional intraoperative colloid. The mean cardiac index and SV at skin closure were significantly higher in the GDT group than in controls. Times to RfD and LOS were longer in GDT than control patients but did not reach statistical significance (median 6.8 vs 4.9 days, P=0.09, and median 8.8 vs 6.7 days, P=0.09, respectively). Fit GDT patients had an increased RfD (median 7.0 vs 4.7 days; P=0.01) and LOS (median 8.8 vs 6.0 days; P=0.01) compared with controls.
  
  
  CONCLUSIONS
  Intraoperative SV optimization conferred no additional benefit over standard fluid therapy. In an aerobically fit subgroup of patients, GDT was associated with detrimental effects on the primary outcome.
  
  
  BACKGROUND
  UK NIHR CRN 7285, ISRCTN 14680495. http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=7285.
authors.affiliation: Directorate of Gastroenterology, Theatres and Pain, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth PL6 8DH, UK.
authors.forename: C
authors.initials: C
authors.lastname: Challand
authors.forename: R
authors.initials: R
authors.lastname: Struthers
authors.forename: J R
authors.initials: JR
authors.lastname: Sneyd
authors.forename: P D
authors.initials: PD
authors.lastname: Erasmus
authors.forename: N
authors.initials: N
authors.lastname: Mellor
authors.forename: K B
authors.initials: KB
authors.lastname: Hosie
authors.forename: G
authors.initials: G
authors.lastname: Minto
mesh_terms: D000368:Aged; D000465:Algorithms; D015179:Colorectal Neoplasms / Q000601:surgery; D003107:Colorectal Surgery; D004311:Double-Blind Method; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006040:Goals; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007430:Intraoperative Care; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D061214:Patient Safety; D019990:Perioperative Care; D010809:Physical Fitness / Q000502:physiology*; D011183:Postoperative Complications / Q000453:epidemiology; D018570:Risk Assessment; D016896:Treatment Outcome