Even Fit Colorectal Surgery Patients (ASA I/II) Benefit from ODM Haemodynamic Monitoring: Fit to Discharge Two days Earlier.

Even Fit Colorectal Surgery Patients (ASA I/II) Benefit from ODM Haemodynamic Monitoring: Fit to Discharge Two days Earlier.

It's well established that patients undergoing major colorectal surgery enjoy improved outcomes when anaesthetists employ Oesophageal Doppler Monitoring-Goal-Directed Fluid Therapy (ODMGDFT). Indeed the authors of a new study remind us that Oesophageal Doppler-guided stroke volume optimisation has the strongest evidence base for improved patient outcomes in elective major surgery across multiple surgical specialities.

A new poster presentation re-examines previous study data¹. However this time investigators isolated those patients considered physiologically fit (ASA I/II) from the overall cohort. The analysis strikingly concludes that ODMGDFT significantly hastens recovery from major surgery in these patients.

The data shows Cardiac Output (CO) in the immediate post-op period was significantly better in the ODM group than the control (Mean 7.66 ODM +/- 2.45 S.D. vs 6.87 control +/- 2.81, P<0.03). The resultant overall improved circulation and oxygen delivery was evidenced in lower Interleukin 6 (marker for inflammation) at 24 hours. Furthermore, ODMGDFT patients saw improved gut function markers and a significantly shortened period before being fit to discharge (9 days vs 11 days).

Investigator Howard Wakeling, Consultant Anaesthetist, University Hospitals Sussex, Worthing Hospital, comments; "The idea that younger, fitter patients have less to gain by using ODMGDFT is proven to be wrong. These data correlate with other studies and help us to confirm the logic that by improving patients' circulation and oxygen delivery we will improve their outcome."

Deltex CEO Andy Mears observes; "These results are reassuringly consistent with findings from the recent FEDORA (multicentre randomised, controlled) study of patients undergoing laparoscopic surgery under an Enhanced Recovery protocol ². In both cases, length of stay was reduced by 2 days.

The new evaluation was presented as a poster at the WCA24 event in Singapore by Dr. Wakeling.

Poster title: Is goal directed fluid therapy using Doppler monitoring more or less relevant to younger, fitter patients during major surgery? Wakeling, H.G. Farrant, M WCA Singapore March 2024 EP14.02.07

References:

1. Intraoperative oesophageal Doppler guides fluid management shorten postoperative hospital stay after major bowel surgery. Wakeling, H.G, Mr R McFall et al Br J Anaesth. 2005 Nov;95(5):634-42.doi

2. Effect of goal-directed haemodynamic therapy on postoperative complications in low-moderate risk surgical patients: a multicentre randomised controlled trial (FEDORA trial), J.M. Calvo-Vecino et al, British Journal of Anaesthesia: CLINICAL PRACTICE/VOLUME 120, ISSUE 4, P734-744, APRIL 2018

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