Flow guided peripoperative resuscitation shortens hospital stay

Studies in surgical patients [1, 2] have suggested that using noninvasive measurements of cardiac output to guide intraoperative fluid resuscitation results in improved patient outcome. We tested this hypothesis in patients for major elective surgery.

Methods

Fifty patients scheduled for major urological surgery were sequentially randomized to a control (C) group or a flow guided (FG) group. In the C group, intraoperative fluids were given according to blood pressure, heart rate and blood loss. In the FG group, in addition to the above, a volume was given to maximize the cardiac output or until a cardiac index of >3.0 l/min/m² was achieved. We used a NICO (Novametrix) noninvasive cardiac output to record continuous measurements of cardiac index. Patients were followed postoperatively by the investigator team, who recorded the return of bowel function and the time to hospital discharge. The decision to discharge patients were made by the surgical team per protocol.

Results

Patient demographics are presented in Table 1. Patients in the FG group were older than in the C group. Patients in the FG group were given significantly more volume/hour of surgery than those in the C group. The time to passage of flatus, the ability to tolerate a soft diet and hospital discharge were all decreased in the FG group (Table 2). There was no difference in morbidity or mortality between the two groups.

Table 1

Table 2

Conclusion

This study sugests that the use of continuous noninvasive measurements of cardiac output to guide intraoperative volume replacement results in more volume being given but in a faster postoperative recovery of bowel function and faster hospital discharge.