title: Goal-directed fluid therapy in major elective rectal surgery.
abstract: BACKGROUND
  Goal-Directed Fluid Therapy (GDFT) has been previously shown to decrease complications and hospital length of stay in major colorectal surgery but the data are not specific to rectal surgery and may be potentially outdated. This study investigated whether GDFT provides clinical benefits in patients undergoing major elective rectal surgery.
  
  
  METHODS
  There were 81 consecutive patients in this cohort study. Twenty-seven patients were allotted to GDFT using the Oesophageal Doppler Monitor (ODM) and received boluses of colloid fluid based on corrected flow time and stroke volume. These patients were compared with a historical cohort of the previous 54 patients managed without the ODM. The primary endpoint of the study was 30-day total complications which were defined and graded. Secondary endpoints included hospital length of stay (LOS) and fluid volumes administered.
  
  
  RESULTS
  There were no differences at baseline between the two groups. Patients in the treatment group received a higher volume of colloid fluids (1000 mL vs. 500 mL; p < 0.01) but there were no differences in overall fluid volumes administered intraoperatively (3000 mL vs. 3000 mL; p = 0.41). A non-significant trend (p = 0.06) suggested that patients allotted to GDFT had decreased fluid requirement in the first 24 h after surgery. There were no differences in median total fluid volumes (12700 mL vs. 10407 mL; p = 0.95), total complications (22 [81%] vs. 44 [81%]; p = 1.00) or median hospital LOS (9 days vs. 10 days; p = 0.92) between the two groups.
  
  
  CONCLUSIONS
  Intraoperative GDFT did not improve clinical outcomes following major elective rectal surgery.
authors.affiliation: Department of Surgery, South Auckland Clinical School, Middlemore Hospital, University of Auckland, Auckland, New Zealand. Electronic address: sanketsri@gmail.com.
authors.forename: Sanket
authors.initials: S
authors.lastname: Srinivasa
authors.affiliation: Department of Anaesthesia, MIddlemore Hospital, Auckland, New Zealand.
authors.forename: Matthew H G
authors.initials: MH
authors.lastname: Taylor
authors.affiliation: Department of Surgery, South Auckland Clinical School, Middlemore Hospital, University of Auckland, Auckland, New Zealand.
authors.forename: Primal P
authors.initials: PP
authors.lastname: Singh
authors.affiliation: Department of Surgery, South Auckland Clinical School, Middlemore Hospital, University of Auckland, Auckland, New Zealand.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Lemanu
authors.affiliation: Department of Surgery, South Auckland Clinical School, Middlemore Hospital, University of Auckland, Auckland, New Zealand.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: MacCormick
authors.affiliation: Department of Surgery, South Auckland Clinical School, Middlemore Hospital, University of Auckland, Auckland, New Zealand.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003102:Colloids / Q000008:administration & dosage; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D055815:Young Adult
chemical_list: D003102:Colloids
keywords: Colorectal; Fluid; Perioperative care