INTRAOPERATIVE VOLUME EXPANSION GUIDED BY ESOPHAGEAL DOPPLER IMPROVED POSTOPERATIVE OUTCOME AND SHORTEN HOSPITAL STAY

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S179 INTRODUCTION: Intraoperative hypovolemia is common and is associated with an increased postoperative morbidity and prolonged hospital stay [1]. Esophageal Doppler (EDM Deltex Med Inc., Irving, Texas) allows non-invasive continuous monitoring of stroke volume (SV) and calculated cardiac output (CO), thus enabling a continuous measure of volume status. We investigated whether optimizing plasma volume with the use of EDM would reduce postoperative morbidity and length of hospital stay. METHODS: Following IRB approval and informed consent, patients undergoing "moderate risk" surgical procedures (major urological, major gynecological with laparotomy, and major general surgical with laparotomy) with an anticipated blood loss >500 ml were studied. All patients received a standardized balanced anesthetic technique. After induction of anesthesia, an EDM probe was inserted via the patient's mouth and positioned in mid-esophagus. Patients were randomized into therapy (T) or control (C) groups. In the T group, intraoperative fluid management was guided by a protocol with 200 ml aliquot of Hespan[trade mark sign] (up to a total of 20 ml/kg) given to obtain a maximum stroke volume and corrected flow time. This procedure was repeated every 15 min until the end of surgery. Lactated Ringer's was used when the Hespan[trade mark sign] maximum volume (20 ml/kg) was reached. Patients in the control group have their fluid managed based on clinical criteria. The EDM parameters were not displayed in the C group (the monitor screen was covered with an opaque card). Data on intraoperative hemodynamics, hospital stay and morbidity were collected. Wilcoxon rank sum test and Fisher exact test were used to analyze data. RESULTS: Forty four patients (Therapy = 21, Control = 23) have completed the study to date. Patient demographics, type and duration of procedures were comparable between the groups. The intraoperative fluid administered, hemodynamic data and recovery data are shown in Table 1 below. One patient in the control group developed postoperative renal dysfunction. There was no difference in blood or blood product usage between groups.Table 1DISCUSSION: Intraoperative fluid optimization guided by EDM appears to be associated with faster recovery and shorten hospital stay.