Oesophageal Doppler monitoring: should it be routine for high-risk surgical patients?

PURPOSE OF REVIEW: To determine whether sufficient evidence exists to justify routine use of oesophageal Doppler monitoring to guide perioperative haemodynamic management in high-risk surgery. RECENT FINDINGS: Systematic reviews of the literature have been performed independently by the National Health Service Centre for Evidence-based Purchasing in the UK, and the US Agency for Healthcare-Related Quality. A before-after evaluation was also recently performed in three hospitals by the National Health Service Technology Adoption Centre. Although multicentre prospective randomized controlled trials are lacking, the evidence base for both outcome-benefit and cost-benefit is considered strong enough by the National Institute for Health and Clinical Excellence in the UK for them to recommend use of this technology in high-risk surgical patients. Whether these findings also apply to other monitoring technologies requires formal validation. SUMMARY: Better patient outcomes can be achieved by perioperative haemodynamic optimization using oesophageal Doppler monitoring and should be considered for routine use in most types of high-risk surgery.