Key result
Goal-directed fluid therapy guided by transesophageal echocardiography significantly shortened first postoperative exhaust time (45 vs 63 hours, P<0.05) compared to restrictive fluid therapy.
Why the study?
Preoperative fasting and bowel preparation complicate volume assessment during intestinal tumour surgery, and inappropriate intraoperative fluid therapy can cause organ damage and worsen prognosis.
Does TEE-guided goal-directed fluid therapy improve postoperative gastrointestinal function recovery in colorectal cancer patients undergoing radical surgery?
RCT (n=54)
Single-blind
randomized
No
Does TEE-guided goal-directed fluid therapy improve postoperative gastrointestinal function recovery in colorectal cancer patients undergoing radical surgery?
Absolute Event Rate: 45% vs 63%
p-value: p=<0.05
Intraoperative fluid therapy guided by TEE monitoring of LVEDVI significantly accelerates gastrointestinal function recovery and shortens hospital stay compared to restrictive fluid therapy in colorectal cancer surgery.
May guide individualized fluid replacement in fasted intestinal tumour surgery patients; leaves open need for larger randomized trials.
Background: Patients undergoing intestinal tumour surgery are fasted preoperatively for a series of bowel preparations, which makes it difficult to assess the patients’ volume, posing a challenge to intraoperative fluid replacement. Besides, inappropriate fluid therapy can cause organ damage and affect the prognosis of patients, and it increases the burden of patients and has a certain impact on patients and families. Material and methods: The authors designed a single-centre, prospective, single-blinded, randomized, parallel-controlled trial. Fifty-four patients undergoing elective radical resection of colorectal cancer were selected and divided into two groups according to whether transesophageal echocardiography (TEE) was used or not during the operation, that is the goal-directed fluid therapy (GDFT) group (group T) guided by TEE and the restrictive fluid therapy group (group C). Fluid replacement was guided according to left ventricular end-diastolic volume index (LVEDVI) in group T and according to restrictive fluid replacement regimen in group C. Results: The first postoperative exhaust time and defecation time in group T [(45±21), (53±24) h] were significantly shorter (P<0.05) than those in group C [(63±26), (77±30) h]. There were no significant differences (P>0.05) in liquid intake time and postoperative nausea and vomiting incidences between the two groups. The total intraoperative fluid volume in group T was significantly higher (P<0.05) than that in group C. There was no significant difference (P>0.05) in urine volume between the two groups. There were no significant differences (P>0.05) in lactate content, mean arterial pressure, and heart rate at various time points between the two groups. The length of hospital stay in group C [(18±4) days] was significantly longer (P<0.05) than that in group T [(15±4) days]. Conclusions: For patients undergoing colorectal cancer surgery, fluid therapy by monitoring LVEDVI resulted in faster recovery of gastrointestinal function and shorter hospital stay.
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du et al. (2024) conducted an RCT in Colorectal cancer (n=54). Goal-directed fluid therapy guided by transesophageal echocardiography vs. Restrictive fluid therapy was evaluated on First postoperative exhaust time (hours) (p=<0.05). Goal-directed fluid therapy guided by transesophageal echocardiography significantly shortened first postoperative exhaust time (45 vs 63 hours, P<0.05) compared to restrictive fluid therapy.
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