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 language | English |
---|---|
Pages (from-to) | 1081-1091 |
Number of pages | 11 |
Journal | Colorectal Disease |
Volume | 19 |
Issue number | 12 |
DOIs | |
Publication status | Published - 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