Doppler-guided intra-operative fluid management during major abdominal surgery: systematic review and meta-analysis

Peri-operative fluid therapy is a controversial area with few randomised trials to guide practice. Recently, a number of trials have suggested that intra-operative therapy guided by oesophageal Doppler acquired haemodynamic variables may improve postoperative outcome.

Abstract databases and conference proceedings were searched to identify randomised controlled trials comparing Doppler-guided intra-operative fluid management to standard practice in patients undergoing major abdominal surgery. Pooled odds ratios (POR) and weighted mean differences (WMD) were calculated for categorical and continuous outcomes respectively.

Four trials, comprising 393 patients, were identified. Use of an oesophageal Doppler-guided fluid management algorithm resulted in fewer postoperative complications (POR 0.32; 95% CI: 0.19-0.52; p < 0.0001) and shorter hospital stays (WMD 1.68 days; 95% CI: 2.39-0.98; p < 0.0001). There were no significant differences in the quantities of intra-operative fluids administered although there was some evidence of heterogeneity with respect to this outcome.

Oesophageal Doppler-guided fluid management may improve outcome following major intra-abdominal surgery. However, comparison with fluid restriction strategies, including a cost-effectiveness analysis are required.