Which goal for fluid therapy during colorectal surgery is followed by the best outcome: near-maximal stroke volume or zero fluid balance?
BACKGROUND
We aimed to investigate whether fluid therapy with a goal of near-maximal stroke volume (SV) guided by oesophageal Doppler (ED) monitoring result in a better outcome than that with a goal of maintaining bodyweight (BW) and zero fluid balance in patients undergoing colorectal surgery.


METHODS
In a double-blinded clinical multicentre trial, 150 patients undergoing elective colorectal surgery were randomized to receive fluid therapy after either the goal of near-maximal SV guided by ED (Doppler, D group) or the goal of zero balance and normal BW (Zero balance, Z group). Stratification for laparoscopic and open surgery was performed. The postoperative fluid therapy was similar in the two groups. The primary endpoint was postoperative complications defined and divided into subgroups by protocol. Analysis was performed by intention-to-treat. The follow-up was 30 days. The trial had 85% power to show a difference between the groups.


RESULTS
The number of patients undergoing laparoscopic or open surgery and the patient characteristics were similar between the groups. No significant differences between the groups were found for overall, major, minor, cardiopulmonary, or tissue-healing complications (P-values: 0.79; 0.62; 0.97; 0.48; and 0.48, respectively). One patient died in each group. No significant difference was found for the length of hospital stay [median (range) Z: 5.00 (1-61) vs D: 5.00 (2-41); P=0.206].


CONCLUSIONS
Goal-directed fluid therapy to near-maximal SV guided by ED adds no extra value to the fluid therapy using zero balance and normal BW in patients undergoing elective colorectal surgery.
Department of Surgical Gastroenterology, Hvidovre University Hospital, Kettegaardsallé 30, 2650 Hvidovre, Denmark. birgitte.brandstrup@hvh.regionh.dk
B
B
Brandstrup
P E
PE
Svendsen
M
M
Rasmussen
B
B
Belhage
S Å
SÅ
Rodt
B
B
Hansen
D R
DR
Møller
L B
LB
Lundbech
N
N
Andersen
V
V
Berg
N
N
Thomassen
S T
ST
Andersen
L
L
Simonsen
D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006040:Goals; D006801:Humans; D007420:Intestine, Large / Q000601:surgery*; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D011183:Postoperative Complications; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods; D014882:Water-Electrolyte Balance / Q000502:physiology*