Executive Summary

Doppler Guided Intraoperative Fluid Management

Optimal management of fluid balance during major surgery is considered a key factor in improving surgical outcomes. Innovative and minimally invasive monitoring of cardiac stroke volume using oesophageal Doppler technology now enables the anaesthetist to safely and accurately administer intravenous fluids during surgery. This reduces the rates of post operative complications as well as reducing the length of critical care and overall hospital stay.

The results of this implementation project demonstrate that encouraging research data can be reproduced in routine NHS clinical and operational practice with a three day reduction in hospital stay and fewer postoperative complications for patients.

Our "How To, Why To Guide" provides a comprehensive introduction to the technology, the supporting Evidence Base (Click Here) and practical, useful information to support its implementation. Our "How to Why To" Guides has been specifically designed to save you time, improve patient outcomes and productivity.

Our Guide explains the Benefits 'v' Barriers, how they were overcome, together with the benefits this technology can bring to your organisation from the lessons learnt at our three clinical implementation sites. The guide provides comprehensive, relevant and practical information for clinicians, managers and other stakeholders on how to implement this technology. There's detailed information on procurement and key policy areas that this technology may impact on, a full business case, and costing model that can be tailored to your Trust's requirements.

The technology explained

Effective intraoperative fluid balance is a key factor for reducing complications in patients undergoing major surgery. As a guide for fluid replacement, continuous Doppler guided cardiac output monitoring allows haemodynamic optimisation ensuring adequate blood perfusion to vital organs. By addressing the risk of occult hypovolaemia, intraoperative fluid management will reduce postoperative complications leading to a three day overall reduction in patient length of stay.

The oesophageal Doppler monitoring allows minimally invasive measurement of cardiac performance. It is used within major surgical procedures such as cancer, transplantation, orthopaedics, colorectal and emergency as a guide for fluid replacement. Placement of a small probe into the oesophagus produces a characteristic waveform which estimates cardiac output and other useful haemodynamic variables which can be used to optimise fluid therapy during surgery.

Summary of clinical evidence

Oesophageal Doppler guided fluid monitoring is minimally invasive compared with methods such as pulmonary artery catheterisation (PAC), traditionally used to monitor haemodynamics during major surgery. Although PAC allows a direct evaluation of cardiac performance, invasive insertion of the catheter can cause arrhythmias, catheter related infections and rupture of the pulmonary artery. The oesophageal Doppler monitoring probe allows direct measurement of cardiac performance whilst being minimally invasive and therefore reducing the significant risks associated with PAC. A characteristic waveform ensures accurate placement of the probe and reliable interpretations of cardiac performance.

Eight randomised control trials have demonstrated Doppler guided fluid management will reduce postoperative complications and hospital length of stay.

For more detailed information about the clinical evidence - Click Here

Key benefits of the technology

Reduced risk. Fewer complications compared with other invasive monitoring techniques (central venous cathetar (CVC), PAC).
Minimal training. Easy insertion/removal of the oesophageal probe. Minimal training is required for the use of the monitor.
Improved patient outcomes. As a guide for fluid replacement during major surgery, the oesophageal Doppler guided fluid management ensures adequate blood perfusion to major organs, reducing the risk of occult hypovolaemia and post-operative complications.
Reduced hospital stay. By addressing the challenge of hypovolaemia, the reduced risk of complications and morbidity has been shown to contribute to an overall reduction in patient length of stay.
Benefits to patients and the NHS. A reduction in complications will enhance patient experience. A reduction in patient length of stay will enhance efficiency and improve patient care pathways.

You can view a summary of the Benefits 'v' Barriers here.

Impact on Key Policy Areas

Implementation of doppler guided intraoperative fluid management will have the following impact key policy areas such as quality of care, patient safety, access, length of hospital stay and productivity.