A prospective comparison of a noninvasive cardiac output monitor versus esophageal Doppler monitor for goal-directed fluid therapy in colorectal surgery patients.
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BACKGROUND: Goal-directed fluid therapy (GDFT) is associated with improved outcomes after surgery. The esophageal Doppler monitor (EDM) is widely used, but has several limitations. The NICOM, a completely noninvasive cardiac output monitor (Cheetah Medical), may be appropriate for guiding GDFT. No prospective studies have compared the NICOM and the EDM. We hypothesized that the NICOM is not significantly different from the EDM for monitoring during GDFT. METHODS: One hundred adult patients undergoing elective colorectal surgery participated in this study. Patients in phase I (n = 50) had intraoperative GDFT guided by the EDM while the NICOM was connected, and patients in phase II (n = 50) had intraoperative GDFT guided by the NICOM while the EDM was connected. Each patient's stroke volume was optimized using 250-mL colloid boluses. Agreement between the monitors was assessed, and patient outcomes (postoperative pain, nausea, and return of bowel function), complications (renal, pulmonary, infectious, and wound complications), and length of hospital stay (LOS) were compared. RESULTS: Using a 10% increase in stroke volume after fluid challenge, agreement between monitors was 60% at 5 minutes, 61% at 10 minutes, and 66% at 15 minutes, with no significant systematic disagreement (McNemar P > 0.05) at any time point. The EDM had significantly more missing data than the NICOM. No clinically significant differences were found in total LOS or other outcomes. The mean LOS was 6.56 ± 4.32 days in phase I and 6.07 ± 2.85 days in phase II, and 95% confidence limits for the difference were -0.96 to +1.95 days (P = 0.5016). CONCLUSIONS: The NICOM performs similarly to the EDM in guiding GDFT, with no clinically significant differences in outcomes, and offers increased ease of use as well as fewer missing data points. The NICOM may be a viable alternative monitor to guide GDFT.
Anesthesia Recovery Period
Digestive System Surgical Procedures
Length of Stay
Published Version (Please cite this version)10.1213/ANE.0000000000000182
Publication InfoElgasim, Magdi; Gan, Tong Joo; Manchester, Amy Kantipong; Miller, Timothy Ellis; Moon, Richard Edward; Nardiello, John; ... White, WD (2014). A prospective comparison of a noninvasive cardiac output monitor versus esophageal Doppler monitor for goal-directed fluid therapy in colorectal surgery patients. Anesth Analg, 118(5). pp. 966-975. 10.1213/ANE.0000000000000182. Retrieved from http://hdl.handle.net/10161/14000.
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Consulting Professor in the Department of Anesthesiology
My current research interests include postoperative nausea and vomiting (PONV), acute postoperative pain, clinical pharmacology of anesthetic drugs and resuscitation fluids as well as database research in postoperative outcomes. Improving Outcome in Surgical Patients: Nausea and vomiting is regarded as one of the most unpleasant experiences in postoperative recovery. To date, there is no single antiemetic which can satisfactorily control PONV. My interests concentrate o
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
Assistant Professor of Anesthesiology
Associate Professor of Anesthesiology
Clinical and research interests are Enhanced Recovery and Perioperative Medicine; with particular interests in fluid management, and perioperative optimization of the high-risk non-cardiac surgery patient.
Professor of Anesthesiology
Research interests include the study of cardiorespiratory function in humans exposed to environmental conditions ranging from 200 feet of seawater depth to high altitude, gas exchange during diving, the pathophysiology of high altitude pulmonary edema, the effect of anesthesia and postoperative analgesia on pulmonary function and monitoring of tissue oxygenation. Ongoing human studies include the use of fractals to study breathing patterns during environmental and perioperative stress, mechanism
Associate Professor of Surgery
Assistant Professor of Anesthesiology
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