Meta-analysis of goal directed fluid therapy using transoesophageal doppler in patients undergoing elective colorectal surgery

Rollins, K.E.; Mathias, N.C.; Lobo, D.N.

Abstract

Background: Intraoperative goal-directed fluid therapy (GDFT) is recommended for intraoperative fluid management for elective colorectal surgery in most perioperative guidelines. However, the evidence in elective colorectal surgery alone is not wellestablished.
The aim of this meta-analysis was to compare the effects of GDFT with conventional fluid therapy on outcomes following elective colorectal surgery.

Methods: A meta-analysis of randomised controlled trials examining the role of transoesophageal Doppler guided GDFT with conventional fluid therapy in adult patients undergoing elective colorectal surgery was performed in accordance with PRISMA methodology. The primary outcome measure was overall morbidity, with secondary
outcome measures of hospital length of stay, time to return of gastrointestinal function, 30-day mortality, acute kidney injury, and surgical site infection and anastomotic leak rates.

Results: A total of 11 studies were included with a total of 1113 patients; 556 who had undergone GDFT and 557 who had undergone conventional fluid therapy. There was no significant difference in any clinical outcome measure studied between GDFT and conventional fluid therapy, including overall morbidity (RR 0.90, 95% CI 0.75 to 1.08, p=0.27, I2=47%, n=991), 30-day mortality (RR 0.67, 95% CI 0.23 to 1.92, p=0.45, I2=0%, n=1039) and hospital length of stay (mean difference 0.01 days, 95% CI -0.92 to 0.94, p=0.98, I2=34%, n=1049).

Conclusions: This meta-analysis does not support the perceived benefits of goal-directed fluid therapy guided by transoesophageal Doppler monitoring in the setting of elective colorectal surgery.

Citation

Rollins, K., Mathias, N., & Lobo, D. (2019). Meta-analysis of goal directed fluid therapy using transoesophageal doppler in patients undergoing elective colorectal surgery. BJS Open, 3(5), 606-616. https://doi.org/10.1002/bjs5.50188

• Journal Article Type: Article
• Acceptance Date: May 9, 2019
• Online Publication Date: Jul 4, 2019
• Publication Date: Oct 1, 2019
• Deposit Date: May 9, 2019
• Publicly Available Date: Jul 5, 2020
• Journal: BJS open
• Electronic ISSN: 2474-9842
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 3
• Issue: 5
• Pages: 606-616
• DOI: https://doi.org/10.1002/bjs5.50188
• Keywords: Goal-directed fluid therapy; Colorectal; Surgery; Outcome; Meta-analysis
• Public URL: https://nottingham-repository.worktribe.com/output/2036138
• Publisher URL: https://onlinelibrary.wiley.com/doi/full/10.1002/bjs5.50188
• Contract Date: May 10, 2019