Newly Published
Perioperative Medicine  |   May 2017
Goal-directed Fluid Therapy Does Not Reduce Primary Postoperative Ileus after Elective Laparoscopic Colorectal Surgery: A Randomized Controlled Trial
Author Notes
  • From the Department of Anesthesia (J.C.G.-I., A.T., D.M., F.C., G.B.), Department of Surgery (B.L.S., A.S.L., P.C., N.P., L.S.F.), and Steinberg–Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery (N.P., L.S.F.), McGill University Health Centre, Montreal, Quebec, Canada.
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication July 23, 2016. Accepted for publication April 3, 2017.
    Submitted for publication July 23, 2016. Accepted for publication April 3, 2017.×
  • Acknowledgments: The authors acknowledge Deltex Medical, Inc. (Chichester, United Kingdom) for loaning the esophageal Doppler monitor.
    Acknowledgments: The authors acknowledge Deltex Medical, Inc. (Chichester, United Kingdom) for loaning the esophageal Doppler monitor.×
  • Research Support: Supported by the Gerard R. Douville Award, granted to Dr. Baldini, McGill University Health Center Research Institute, Montreal, Quebec, Canada.
    Research Support: Supported by the Gerard R. Douville Award, granted to Dr. Baldini, McGill University Health Center Research Institute, Montreal, Quebec, Canada.×
  • Competing Interests: Dr. Baldini’s academic research funding was used to purchase the esophageal Doppler probes. The other authors declare no competing interests.
    Competing Interests: Dr. Baldini’s academic research funding was used to purchase the esophageal Doppler probes. The other authors declare no competing interests.×
  • Reproducible Science: Full protocol available at: gabriele.baldini@mcgill.ca. Raw data available at: gabriele.baldini@mcgill.ca.
    Reproducible Science: Full protocol available at: gabriele.baldini@mcgill.ca. Raw data available at: gabriele.baldini@mcgill.ca.×
  • Correspondence: Address correspondence to Dr. Baldini: Department of Anesthesia, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Ave, D10.145.2, Montreal, Quebec H3G 1A4, Canada. gabriele.baldini@mcgill.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Gastrointestinal and Hepatic Systems / Renal and Urinary Systems / Electrolyte Balance
Perioperative Medicine   |   May 2017
Goal-directed Fluid Therapy Does Not Reduce Primary Postoperative Ileus after Elective Laparoscopic Colorectal Surgery: A Randomized Controlled Trial
Anesthesiology Newly Published on May 4, 2017. doi:10.1097/ALN.0000000000001663
Anesthesiology Newly Published on May 4, 2017. doi:10.1097/ALN.0000000000001663
Abstract

Background: Inadequate perioperative fluid therapy impairs gastrointestinal function. Studies primarily evaluating the impact of goal-directed fluid therapy on primary postoperative ileus are missing. The objective of this study was to determine whether goal-directed fluid therapy reduces the incidence of primary postoperative ileus after laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program.

Methods: Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Patients were assigned randomly to receive intraoperative goal-directed fluid therapy (goal-directed fluid therapy group) or fluid therapy based on traditional principles (control group). Primary postoperative ileus was the primary outcome.

Results: One hundred twenty-eight patients were included and analyzed (goal-directed fluid therapy group: n = 64; control group: n = 64). The incidence of primary postoperative ileus was 22% in the goal-directed fluid therapy and 22% in the control group (relative risk, 1; 95% CI, 0.5 to 1.9; P = 1.00). Intraoperatively, patients in the goal-directed fluid therapy group received less intravenous fluids (mainly less crystalloids) but a greater volume of colloids. The increase of stroke volume and cardiac output was more pronounced and sustained in the goal-directed fluid therapy group. Length of hospital stay, 30-day postoperative morbidity, and mortality were not different.

Conclusions: Intraoperative goal-directed fluid therapy compared with fluid therapy based on traditional principles does not reduce primary postoperative ileus in patients undergoing laparoscopic colorectal surgery in the context of an Enhanced Recovery After Surgery program. Its previously demonstrated benefits might have been offset by advancements in perioperative care.

Abstract

TOC Statement: This randomized blinded trial assessed effects of goal-directed fluid therapy on primary postoperative ileus after laparoscopic colorectal surgery, within a well-established Enhanced Recovery After Surgery program. The incidence of primary postoperative ileus was identical (22%) in the goal-directed fluid therapy control groups. Previous benefits of goal-directed fluid therapy may have been offset by subsequent improvements in perioperative and surgical care.