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dc.contributor.authorChalland, C
dc.contributor.authorStruthers, R
dc.contributor.authorSneyd, JR
dc.contributor.authorErasmus, PD
dc.contributor.authorMellor, N
dc.contributor.authorHosie, KB
dc.contributor.authorMinto, G
dc.date.accessioned2012-11-09T21:54:53Z
dc.date.accessioned2012-11-09T21:57:11Z
dc.date.available2012-11-09T21:54:53Z
dc.date.available2012-11-09T21:57:11Z
dc.date.issued2012-01
dc.identifier.issn0007-0912
dc.identifier.issn1471-6771
dc.identifier.urihttp://hdl.handle.net/10026.1/1213
dc.description.abstract

BACKGROUND: Intraoperative fluid therapy regimens using oesophageal Doppler monitoring (ODM) to optimize stroke volume (SV) (goal-directed fluid therapy, GDT) have been associated with a reduction in length of stay (LOS) and complication rates after major surgery. We hypothesized that intraoperative GDT would reduce the time to surgical readiness for discharge (RfD) of patients having major elective colorectal surgery but that this effect might be less marked in aerobically fit patients. METHODS: In this double-blinded controlled trial, 179 patients undergoing major open or laparoscopic colorectal surgery were characterized as aerobically 'fit' (n=123) or 'unfit' (n=56) on the basis of their performance during a cardiopulmonary exercise test. Within these fitness strata, patients were randomized to receive a standard fluid regimen with or without ODM-guided intraoperative GDT. RESULTS: GDT patients received an average of 1360 ml of additional intraoperative colloid. The mean cardiac index and SV at skin closure were significantly higher in the GDT group than in controls. Times to RfD and LOS were longer in GDT than control patients but did not reach statistical significance (median 6.8 vs 4.9 days, P=0.09, and median 8.8 vs 6.7 days, P=0.09, respectively). Fit GDT patients had an increased RfD (median 7.0 vs 4.7 days; P=0.01) and LOS (median 8.8 vs 6.0 days; P=0.01) compared with controls. CONCLUSIONS: Intraoperative SV optimization conferred no additional benefit over standard fluid therapy. In an aerobically fit subgroup of patients, GDT was associated with detrimental effects on the primary outcome. TRIAL REGISTRY: UK NIHR CRN 7285, ISRCTN 14680495. http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=7285.

dc.format.extent53-62
dc.format.mediumPrint-Electronic
dc.languageen
dc.language.isoeng
dc.publisherElsevier BV
dc.relation.replaceshttp://hdl.handle.net/10026.1/1212
dc.relation.replaces10026.1/1212
dc.subjectassessment
dc.subjectgoal-directed therapy
dc.subjectpatient outcomes, colorectal surgery, exercise test, fluid balance
dc.titleRandomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery
dc.typejournal-article
dc.typeArticle
plymouth.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/21873370
plymouth.issue1
plymouth.volume108
plymouth.publisher-urlhttp://dx.doi.org/10.1093/bja/aer273
plymouth.publication-statusPublished
plymouth.journalBritish Journal of Anaesthesia
dc.identifier.doi10.1093/bja/aer273
plymouth.organisational-group/Plymouth
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Users by role
dc.publisher.placeEngland
dc.identifier.eissn1471-6771
dc.rights.embargoperiodNot known
rioxxterms.versionofrecord10.1093/bja/aer273
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.typeJournal Article/Review


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