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- Title
Doppler-guided goal-directed fluid therapy does not affect intestinal cell damage but increases global gastrointestinal perfusion in colorectal surgery: a randomized controlled trial.
- Authors
Reisinger, K. W.; Willigers, H. M.; Jansen, J.; Buurman, W. A.; Von Meyenfeldt, M. F.; Beets, G. L.; Poeze, M.
- 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.
- Subjects
PROCTOLOGY; GASTROENTEROLOGY; RANDOMIZED controlled trials; PERFUSION; CANCER chemotherapy
- Publication
Colorectal Disease, 2017, Vol 19, Issue 12, p1081
- ISSN
1462-8910
- Publication type
Article
- DOI
10.1111/codi.13923