What is the optimal type of fluid to be used for peri-operative fluid optimisation directed by oesophageal Doppler monitoring?
Article first published online: 13 JUN 2011
© 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland
Volume 66, Issue 9, pages 819–827, September 2011
How to Cite
Morris, C. and Rogerson, D. (2011), What is the optimal type of fluid to be used for peri-operative fluid optimisation directed by oesophageal Doppler monitoring?. Anaesthesia, 66: 819–827. doi: 10.1111/j.1365-2044.2011.06775.x
- Issue published online: 11 AUG 2011
- Article first published online: 13 JUN 2011
- Accepted: 6 April 2011
The objective of this review was to determine the optimal type or class of intravenous fluid to be used during peri-operative patient optimisation guided by oesophageal Doppler monitoring and to identify future directions for research. We undertook a literature review of patients undergoing major (general, colorectal, orthopaedic and urological) surgery, whose fluid therapy was managed using peri-operative oesophageal Doppler monitoring. We identified 10 studies that included 891 randomised patients. A variety of regimens and types of fluid were used in association with oesophageal Doppler monitoring, including crystalloid, gelatin and hydroxyethyl starch. A wide variety of hydroxyethyl starch preparations were used, including high molecular weight and highly substituted hetastarches, and lower molecular weight tetrastarches. Most studies were of high quality, associated with reduced hospital stay, but underpowered to evaluate other outcomes. In units with established enhanced recovery facilities, the benefits of colloid based on oesophageal Doppler monitoring were not reproduced. There is little evidence to support preferential use of any particular type of fluid during oesophageal Doppler guided optimisation; however, routine use of colloids is associated with significantly higher costs and may increase hospital stay. Furthermore, many of these fluids have not been evaluated in patient populations in whom optimisation is being applied or proposed, and the potential for harm cannot be excluded. Recommendations for future studies are provided, including adequate power for primary end points beyond hospital stay and adequate follow-up, and inclusion of a crystalloid comparison group.