Intra-Operative IV Fluid Management: Goal Directed Therapy with Esophageal Doppler Monitoring vs. Standard Weight Based Fluid Therapy

Intravenous fluid management in the peri-operative period continues to be a debate in the anesthesia literature in terms of which fluid type is best along with how much fluid should be given. The majority of post-operative complications in colo-rectal surgery can be traced back to the amount of IV fluids patients receive. Most recently the term Goal- directed therapy (GDT) states that a more individualized approach to fluid management is not only safer but necessary. The Esophageal Doppler, a technology analyzing stroke volume and cardiac output intra-operative, may prove to be a safe way to provide GDT and decrease complications post-operatively. This systematic review examined the impact of the esophageal Doppler versus the traditional weight based fluid management technique on adult (>18 years of age) patient outcomes post-operatively after colo-rectal and abdominal surgery. The goal was to highlight best practices that will decrease adverse patient events and length of stay (LOS). Four out of the five randomized controlled trials analyzed for this review do report that ED use and GDT decrease complications and ICU admissions post-operatively versus utilizing a more standard approach to fluid management. Due to other social variables in discharging subjects, length of stay was not found to be decreased in GDT subject groups. In furthering anesthesia practice, standard fluid management techniques should be updated with a more individualized approach focusing on patient variables such as stroke volume and what the response is to fluid therapy intra-operatively.