Doppler-guided goal-directed fluid therapy does not affect intestinal cell damage but increases global gastrointestinal perfusion in colorectal surgery: a randomized controlled trial

K. W. Reisinger*, H. M. Willigers, J. Jansen, W. A. Buurman, M. F. Von Meyenfeldt, G. L. Beets, M. Poeze

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Aim Individualized, goal-directed fluid therapy (GDFT), based on Doppler measurements of stroke volume, has been proposed as a treatment strategy in terms of reducing complications, mortality and length of hospital stay in major bowel surgery. We studied the effect of Doppler-guided GDFT on intestinal damage as compared with standard postoperative fluid replacement.

Method Patients undergoing elective colorectal resection for malignancy were randomized either to standard intra- and postoperative fluid therapy or to standard fluid therapy with additional Doppler-guided GDFT. The primary outcome was intestinal epithelial cell damage measured by plasma levels of intestinal fatty acid-binding protein (I-FABP). Global gastrointestinal perfusion was measured by gastric tonometry, expressed as regional (gastric) minus arterial CO2-gap (Pr-aCO2-gap).

Results I-FABP levels were not significantly different between the intervention group and the control group (respectively, 440.8 (251.6) pg/ml and 522.4 (759.9) pg/ml, P=0.67). Mean areas under the curve (AUCs) of intra-operative Pr-aCO2-gaps were significantly lower in the intervention group than in the control group (P=0.01), indicating better global gastrointestinal perfusion in the intervention group. Moreover, the mean intra-operative Pr-aCO2-gap peak in the intervention group was 0.5 (1.0) kPa, which was significantly lower than the mean peak in the control group, of 1.4 (1.4) kPa (P=0.03).

Conclusion Doppler-guided GDFT during and in the first hours after elective colorectal surgery for malignancy increases global gastrointestinal perfusion, as measured by Pr-aCO2-gap.

Original languageEnglish
Pages (from-to)1081-1091
Number of pages11
JournalColorectal Disease
Volume19
Issue number12
DOIs
Publication statusPublished - Dec 2017

Keywords

  • Fluid therapy
  • colorectal surgery
  • intestinal fatty acid-binding protein
  • perfusion
  • STROKE VOLUME OPTIMIZATION
  • CLINICAL-TRIAL
  • CRITICALLY-ILL
  • CARDIAC-OUTPUT
  • BOWEL SURGERY
  • ORGAN FAILURE
  • RESPONSIVENESS
  • MANAGEMENT
  • PREDICTION
  • COLECTOMY

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