A prospective comparison of a noninvasive cardiac output monitor versus esophageal doppler monitor for goal-directed fluid therapy in colorectal surgery patients
Abstract
Copyright © 2014 International Anesthesia Research Society. 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.
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https://hdl.handle.net/10161/17265Published Version (Please cite this version)
10.1213/ANE.0000000000000182Publication Info
Waldron, Nathan H; Miller, Timothy E; Thacker, Julie K; Manchester, Amy K; White,
William D; Nardiello, John; ... Gan, Tong J (2014). A prospective comparison of a noninvasive cardiac output monitor versus esophageal
doppler monitor for goal-directed fluid therapy in colorectal surgery patients. Anesthesia and Analgesia, 118(5). pp. 966-975. 10.1213/ANE.0000000000000182. Retrieved from https://hdl.handle.net/10161/17265.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Tong Joo Gan
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.
Amy Kantipong Manchester
Assistant Professor of Anesthesiology
Timothy Ellis Miller
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.
Richard Edward Moon
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 mechanisms of immersion pulmonary
edema and the effect of chemosensitivity on postoperative ventilation
Nathan Hunter Waldron
Assistant Professor of Anesthesiology
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